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PERMIT APPLICATION <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 e <br />LE-GAQ LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />1 '�Ilc ✓�i�//I/,ZeO 5! 0/ Lw'dex L/!/ <br />TENANT NAME I <br />CONTACT NAME PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE e <br />si . S 7 /a��frt� L-?/�ILGSSo�2oT <br />PHON16/lG�ti <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building �lech nIat <br />Combination lumbing <br />WORK <br />#ation <br />MEATSOURCE <br />Electric <br />/ate/^��TYPE <br />BDemolition Sign <br />TYPE <br />fA.�dion <br />Nw <br />s <br />/7J 6 <br />Sprinkler <br />Repeir/Maint. <br />II <br />Omer <br />CONTRACT PRICE OF WORK ./ [1,y1 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR REM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />A/C — AMANDLING UNITS <br />BATHTUB <br />Z <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />Z <br />WATER HEATER <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE'BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <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 />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 GIVE AUTHr'71TY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />S ATE OR LOC LAW REGULATING CONSTRUCTION OR THE PERFORM, CE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER IS P OPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT CTOR�1a.27 RCYy AN i 1)0 WAC. <br />� <br />/7-4�—dam <br />Signat e o wneu ontractor/ uth nzed Agent ata <br />