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�ERMIT APPLICATfUN <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 />, <br />PARCEL TAX I.D. N <br />V <br />PERMIT <br />C <br />I' <br />a 5- / 0 Cc�' <br />/�mf Did <br />UES L <br />LOT No. <br />LOCK <br />TRACT <br />1j <br />OWNER <br />l <br />_ ADDRESS <br />� ZIP <br />PHONE��� <br />lC <br />TENAN <br />NAME <br />CONTACT FOR PERMIT <br />PHONE <br />CONTRACTOR <br />ADDRESS <br />ZIP <br />CONTR. LICENSE it <br />PHONE <br />RaOPOSED USE C UILDING IS�BUi'ding McChanical ,addition HEAT 60URCE <br />PERMIT I{L-L-j{)( Combination Plumbing WORK Alteration lectnc <br />HYPE Ormnlition D Sign TYPE I(K`�Y{. New Gas <br />Sprinkler RepautMaint. - Otner <br />CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />w 1441 <br />NO. i TYPE OF FIXTURE OR ITEM <br />_ WATER CLOSET (TOILET) <br />_ BATHTUB <br />_ LAVATORY (WASH BASIN) <br />_ SHOWER <br />_ KITCHEN SINK 8 DISPOSAL <br />_ DISHWASHER <br />_ LAUNDRY TRAY <br />_ CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF FIXTIIPE : ,. ITEM <br />_ AC --k/HANDLING UNITS <br />_ FORCED AIR SYSTr`oS <br />_ HEAT PUMP <br />_ UNIT HEI.TERS <br />_ CLOTHES DRYER <br />_ RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />_ GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <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 OP.IOINACES 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 />uvvNER OF THIS PROPERTY TO PEFFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTFIACTORS LAW 18.27 ROW AND 296.200SNAC. ,--, / <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />