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P6MIT APPLICATi6N <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 />PARCEL TAX I.D. # <br />PERMIT # <br />M �l -oo <br />�-Itt Gr�1�d uc <br />0060SS-0 L2A0 ��O <br />.l <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. 3 2Z <br />ZIP PHONE <br />OWNER <br />l �C 3ZADDRESS <br />OC&,r � -- l,E 3-7 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />Pktf �ssl�� uzs-31-6--6c,37 <br />CONTRALTOg� / `/ ADDRESS * �� ZZIP CONTR. LICENSE # <br />N� r}' J5h/ L 1 17031 33 iluc <br />PHONE g9A.tI��L >3261 <br />1-1Z5=7N3-17 /V I'r <br />PROPOSED USE OF BUILDING <br />Ii <br />Building I� Mechanical <br />IIF-.--J(( <br />Addition <br />HEAT SOURCE <br />D Electric <br />PERMIT I�UKt( <br />Combination Plumbing <br />WORK <br />H Alteration <br />TYPE <br />Demolition Sign <br />TYPE <br />New <br />B Gas <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />WORK DESCRIPTION <br />/YlnA- <br />t <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET (TOILET) <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />_ <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEI ! SINK & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACEISTOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />GAS PIPING <br />_ <br />BACKFLOW PREVENT[ <br />SINK (SERVICE/BAR/MOl'/ETC.) <br />_ <br />EXHAUST FAN <br />_ <br />OTHER <br />_ <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING <br />NOT. THE GRANTING OFPERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />.A <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE 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 WITH THE STATE <br />CONTRACTORS LAW 16.27 RCW AND 296.200 WAC. <br />Signatu•e of Owner/Contractor/Authorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />