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PERMIT APPLICATION <br />PERMIT APPLICATION <br />i <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 # <br />nn <br />(� �C11 I� Z n�'e <br />N G'-tir4' C 3 <br />i. <br />p <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />/iIICII(ijf' Q$ r h% -2 �2_?, 26,111�UL Auc C182.v1 _ <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS 21P CONTR. LICENSE # <br />A 1 (L G)rrc <br />No— 2NC /�� <br />W 1F 0f if ZOy �l_T �L �-%2-P 14 <br />PHONE <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />R Combination � Plumbing <br />WORK <br />� Alteration <br />Electric <br />TYPE <br />B Demolition Sign <br />TYPE <br />New <br />Gas <br />� <br />.I <br />Sprinkler <br />RepairlMainL <br />Other <br />CONTRACT PRICE OF WORK , �J <br />99 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 — <br />WORK DESCRIPTION <br />PLUMBING <br />'MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET (TOILET) <br />A/C - A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 3 DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />X <br />GAS RANGE I <br />_ <br />BACKFLOIN PREVENTER <br />GAS PIPING I <br />SINK (SERVICGBARIIdOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />� <br />OTHER Gay LVQHCf � <br />I <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 RE 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 />CONTRACT RS LAW 18.27 RCLV AND 296200 WAC. <br />Signature of OwnedConlractorrAuthonzeU Agent Date <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />