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(aJERMIT APPLICA t .ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. N PERMIT 0 <br />000 I �7�i0%qi <br />LEGA LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS 21P PHONE <br />/ <br />_ CoMMK�/fy �rtihs/`t' <br />/ <br />TENANT NAME <br />CONTACT NAME PHONE <br />nn <br />/COI, :;m— S%i — -7 3p/ <br />CO RACTO(.. ADDRESS <br />/V195 PCONTR.0CENSE <br />�� ZIY8029 <br />GBSYSM <br />.,HONE <br />y,25-- yet -0 5 Fc� <br />PROPOSED USE OF BUILDING I <br />f� Building I") Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />IIUj(( Combination KKJ Plumbing <br />WORK <br />Alteration <br />QQ Electric <br />TYPE <br />Demolition LSign <br />TYPE <br />New <br />N <br />Gas <br />Sprinkler <br />Repair/Maint <br />Other <br />CONTRACT PRICE OF WORK j�000 / 00 CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION —` <br />2- /Z��- <br />i <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />_ <br />SHOWER <br />112: <br />UNIT HEATERS <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />_ <br />RANGE HOOD <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />CLOTHES WASHER <br />_ <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />DRINKING FOUNTAIN <br />_ <br />_ <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />_, <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />SINK (SERVICEidAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHEFl <br />_ <br />I HEREnr CEHi t iFr ; HA I 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 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 THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LkW 18.27 RCW AND 296.200 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />tL <br />