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R.RMIT APPLICATI. N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />2�/ Grg1n <br />PARCEL TAX I.D. 0 <br />-7 <br />PERMIT 0 <br />I <br />OCxf Co�ioi <br />�Ja207-4'L <br />LEGA LOT NO.� <br />BLOCK <br />TRACT <br />DESC'lrC <br />OWNER ADDRESS � ZIP PHONE <br />6 m � � J�(C1� U ly — r C <br />TENANT NAME CONTACT NAME PHONE <br />_ ,1 <br />CONTRACTOR Q� QADDDR`ESj/gL, ZIP CONTR. LICENSE 0 <br />1 v ' ' CL�Q�R <br />PHONE �Nr,�f <br />PROPOSED USE OF BUILDING <br />PERMITfSprinkler <br />Building Mechanical <br />R Plumbing <br />WORKgRepair/Maint. <br />Addition <br />Alt ration <br />FEAT SOURCE <br />Eies <br />{'�']J\/C <br />_- UU <br />TYPE <br />Demolition D Sign <br />Demoiition <br />TYPENew <br />Gas <br />Other <br />CONTRACT PRICE OF WORK J O� �� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3103 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR REM <br />NO. TYPE OF FIXTURE OR REM <br />WATER CLOSET <br />_ <br />A/C — AIHANDLING UNITS <br />_ <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOH DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <br />SINK (SERVICE/BARMOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER <br />I HEREBY GERI TIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDIN'ACES GOVERNING THIS n'PE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TH ERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC SLAW RC AND 296.200 WA <br />Sign a 3�ned ontractor/Authonze gent Date <br />