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E cRMIT APPLICAtJN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE AODRES�, Z C/ PARCEL TAX I.D. N PEFIMIT 0 <br />.M0aD7_�c. <br />LOT NO. I BLOCK I TRACT <br />h1 RS-V C� <br />ZIP PHONE <br />TENANT NAME (Y)_-- CONTACT NAME PHONE <br />IT 4,- Cal I��T«C.�.� J, .1,� �(� �t2 5 �� 33 <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE a <br />PHONE G ' f <br />PROPOSED USE OF BUILDING Building 5ti Mechanical Addition HEAT SOURCE <br />PERMIT N Combination fL,iPlumbing WORK Alteration li Electric <br />TYPE Demolition Sign TYPE New ILKJ1 Gas <br />pa Sprinkler fleir/M;tint. Other <br />CONTRACT PRICE OF WORK I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DES:RIPTIOH <br />C �- z' <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />, <br />_ <br />2 <br />A/C—AIHANDLING UNI i S <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />W ATER HEATER <br />V_­TA.L FIREPLACE/STOVE <br />FIREPLACE INSERT <br />'3AS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINLD THIS APPLICATION AND KNOW THE SAME TO SE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G F. AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PL-RFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITF. THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />Signature of Owner/Contractor/Aulhonzed Agent Date <br />