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I I <br />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 It <br />LEGA LOT NO. <br />DESC. <br />BLOC36/ <br />TRACT <br />OWNER ADDRESS ZIP PHONE <br />(� z/3 ST S L-J 9/037 y25- 7s-16 9 <br />\^ <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE N <br />PHONE , /2� 7 `,�-`,_I <br />`O <br />PROPOSED USE OF BUILDING <br />Building li Mechanical <br />PERMIT R Combination Plumbing <br />WORK <br />Addition <br />R Alteration <br />HEAT SOURCE <br />(� Electric <br />TYPE DemoliEon Sign <br />TYPE <br />B New <br />B Gas <br />Sprinkler <br />Repair/Maim. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF 'LOCAL SALES TAX CODE IS 9105 <br />WO K DESCRIPTION <br />oe-- <br />PLUMBING <br />MECHANICAL <br />N0. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A1C — A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />_UNIT <br />HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />_CLOTHES <br />DRYER <br />_ <br />DISHWASHER <br />_RANGE <br />HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />_METAL <br />FIREPLACE/STOVE <br />_ <br />URINAL <br />_FIREPLACE <br />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/h10P/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER <br />OTHER <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 ORID!NACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTIIIG 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 LAW 18.27 RCW AND 296.200 WAC. <br />S,n�Wfc�o Owner/Cont��/Authors ed Agent Date <br />DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br />