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rERMIT APPLICAT`'�JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.k PERMIT M <br /> � �D � �11v. L ' �," m 03G�-I-Cl 2- � <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADOpESS Z1P PHONE <br /> t-�c�lccv` �c�cC"�-S� 2vl�a oc�ks '�25 �S�-CnoSo <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR AOORESS ZIP CONTR.LICENSE N <br /> PH�NE b W�.�� �I �-�— �-5 f- — COO S�U <br /> PROPOSED USE OF BUILDING Building Mechanical Addition MEAT SOURCE <br /> PERMIT B Combination �Plumbing WORK R Alteration � Electric <br /> TYPE D Demolition p Sign 7YPE D New Gas <br /> U Sprinkler �� RepeidMaint Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR REM N0. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB � FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACElSTOVE <br /> URINAL FIREPLACE INSERT <br /> URINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER � GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHErI ___ <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 WHEfHER 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 A1ADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW A 296200 WAC. <br /> �r a2 <br /> Signawre of w t/ContractodAu orized Agent Date <br /> � DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />