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�ERMIT APPLICATION go563-or7 <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 />PENAIT# <br />75o1 ads, rrz <br />2o30HV7-oo2oa2o� <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />Z rnmtroxavi ?1k,% � 3Lt f "AA-c j"j <br />is a nSl4ncC no ZGy e�/l' ,fie <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />AC55•�r �1Jttyc.�� <br />� <br />f�•rn -1)%l✓LSe)x) 253- 8T F�-97So <br />CONTRACTORDDRESS 2G2� ZIP CONT�{R.r LICENSE#Q <br />0 /•mac-l.rue. <br />PHONE QOpOCI <br />va[(cy �wy. <br />/i/. <br />PROPOSED USE OF BUILDING I I-i <br />Building I� Jvtechanical <br />ddition <br />HEAT SOURCE <br />PERMIT <br />Combination Plumhing <br />WORK <br />Alteratlon <br />Electric <br />I <br />{IfL--.,1(�' <br />TYPE <br />Demolition Sign <br />ItR <br />TYPE <br />New <br />Gas <br />Sprinkler <br />Repair/MainL <br />Other <br />CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />6w, cck <br />PLUMBING <br />MECHANICAL <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />3 <br />WATER CLOSET (TOILET) <br />— <br />A/C - A/HANDLING UNITS <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />N <br />LAVATORY (WASH BASIN) <br />— <br />HEAT PUMP <br />SHOWER <br />_ <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />_ <br />CLOTHES DRYER <br />1_ <br />DISHWASHER <br />— <br />RANGE HOOD <br />LAUNDRY TRAY <br />— <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />_ <br />METAL FIREPLACE/STOVE <br />1 <br />URINAL <br />_ <br />FIREPLACE INSERT <br />1 <br />DRINKING FOUNTAIN <br />_ <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />— <br />GAS RANGE <br />BACKFLOW PREVENTER <br />_ <br />GAS PIPING <br />SINK (SERVICE/BAR/MOPrETC.) <br />_ <br />EXHAUST FAN <br />I <br />I <br />OTHER <br />— <br />OTHER <br />_ <br />I HEREBY CERTIFY 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 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 1.0 PERFORM Ttjf-�RK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONT 18.27 ,CW AND 2 ri M0yiAC. <br />i <br />- 4-0 <br />Sig a O r/C01f racto Aal on Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />