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P�tRNl�T APPLICATI�N <br /> CITY OF FVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.M PERMIT# <br /> y c�' 6�r � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE L� �'/,� Qr � <br /> �I(�n J� � ri�� J'�a-'-� l`J�raS�- Sv�/. Rk037 �`�'- " <br /> TENANTNAME , CONTACTFORPERMIT PHONE <br /> T'�<'�c �2 a I i n�. bu�� <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE N <br /> PHONE <br /> PROPOSED USE OF BUILDING � Building Mechanical Addition HEAT SOURCE <br /> PERMIT Combinalion R�( Plumbing WORK Alteratlon ElecUic <br /> TYPE Demolitlon Ll Sign TYPE New �Gae <br /> Sprinkler Rep•nrlMain�. �U Othar <br /> CONTRACT PRICE OF WORK fITY OF EVERETT LOCAL ttALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> � ns�ul( i���� Gas S� a �^-� , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO.. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/l:—A/HANDLING UNITS <br /> BATHTUB _ FORCEU AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> D�SHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY ,_ WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL IREPLAC�INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BARIMOPIETC.) _ EXHAUST FAN <br /> OTHER ,_ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAA7INED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I ?ROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS IYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRGSUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL L AW 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 /> CONT�ORS LAW 18.27 RC AND 29�200 WAC. <br /> ' F _ �o -l�f 'D.3 <br /> Signature o wne/ ont ctor/Authonze Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />