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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEU�R STREET, EVERETT, WA 98201 <br /> 42�-�57-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> oZ� OA-K.� �Cvi. ►'VIC�`10(-�I� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> Sfl-s� K.E*�U�oy 1 5�a�- o�K�-s � E� 4�s s�i4-�-a-e ae <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> —� ��'►"�E <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE A <br /> PHONE � <br /> �FW�S' /N�STRC.l,M70N�S• <br /> PROPOSED USE OF BUILDING BUilding MBChanlCal Addition HEAT SOURCE <br /> PERMIT R Combination R Plumbing WORK �Alteratlon � Eiectric <br /> TYPE D Demolition � Sign TYPE New Gas <br /> U Sprinkle� Repair/Maint. Other <br /> CONTRACT PRICE OF WORK ��� ���� CITY OF EVERETT LOCAL SALES TN(CODE IS 3105 <br /> WORK OESCRIPTION N�L�� �rE M�.�2 /NS i�P�C�I-L'�D <br /> 6i <br /> TtiS77�u�.�G- G+r� PipiN�, C�'ts iN sE+�-� �- Na�rw�E�R T�N K- <br /> PLUMBING MECHANICAL <br /> NO. TYpE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C–A/HANDLING UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNITHEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER R.4NGE HOOD <br /> _ LAUNDRY TRAY � WATER HEATER <br /> _ CLOTHES WAFHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN � GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER � GAS PIPING <br /> _ SINK(SERVICE/BAR/MOPIETC.) EXHAUST FAN <br /> _ OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND E:(AMINED 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 FERMIT DOES NOT PRESUME TO GIVE AUTNORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL lAW REGUTATING CONSTRU(:TION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE INORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CO TRACTORS W 18.27 RCW AND 296.200 WAC. <br /> l-ia-o4 <br /> Sig ture of OwneNContractodAuthonzed Agent Date <br /> DEBIT� CREDIT CARDS ARE NOT ACCEPTED <br />