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�ERMIT APPLICATION <br />i 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 />(�-- <br />L GA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />2 � 4 -�z 1—'lri3 ZcS % �' <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />3jj.c1 xi�o✓y -3s � -y939 <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />/� <br />PHONE PC/ 1 I(/�C�/(� <br />PROPOSED USE OF BUILDING <br />„_. <br />PERMIT <br />Buildig fi Mechanical <br />Cn Plumbing <br />R ombination <br />Addition <br />WORK � Alteration <br />HEAT SOURCE <br />D Electric <br />M <br />TYPE <br />LtR+xIE <br />B Demolition Sign <br />TYPE New <br />Gas <br />0' <br />Sprinkler <br />RepairlMaint. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />vv" LNG <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />N0. TYPE OF FIXTURE OR ITEM <br />L <br />WATER CLOSET (TOILET) <br />A/C —A/HANDLING UNITS <br />1 <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 DISPOSAL <br />_CLOTHES <br />DRYER <br />DISHWASHER <br />_RANGE <br />HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />_METAL <br />FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />_GAS <br />FIREPLACE <br />_ <br />FLOOR DRAIN <br />_GAS <br />RANGE <br />_ <br />BACKFLOW PREVENTER <br />_GAS <br />PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <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 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 LA 8.27 RCW AND 296.200 WAC. [, <br />6 -3 —a 3 zo <br />Sign ure of O nenC actor/Authorized Agent Date <br />�] '1� <br />BIT &CREDIT CARDS ARE NOT ACCEPTE <br />