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PERMIT APPLICAI ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881L -FAX 425-257-8857 /' <br />SITE ADDRESS PARCEL TAX I.D. # PER kIlIT # <br />LEGAL LOT NO. BLOCK TRACT <br />UVVNMR <br />�/6o.n� <br />// <br />lT�� <br />� ADDRESS _ <br />e7�Z, <G <br />ZIP PHONE <br />TENANT NAME <br />I CONTACT FOR PERMIT <br />PHONE <br />�— <br />CONTRACTOR <br />ADDRESS <br />ZIP CONTR. LICENSE # <br />PHONE <br />PROPOSED USE OF BUILDING <br />�') Building Mechanical <br />Addition <br />HEAT SOURCE <br />j <br />PERMIT {jI( <br />I <br />Combination Plumbing <br />WORK <br />I <br />Alteration <br />Electric <br />TYPE <br />Demolition Sign <br />TYPE <br />New <br />Gas <br />D <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK /I !//J <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />WORK DESCRIPTION <br />1p(-2LA.1 k11 SC - <br />PLUMBING <br />NO. j TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEiBAR/MOP/ETC.) <br />OTHER <br />—I <br />_Q <br />Q <br />�_ <br />I <br />_ I <br />4 <br />Q <br />/ O <br />1 <br />(- 01 <br />A/C-A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <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 />EXHAUST FAN <br />OTHER <br />_ <br />J_ <br />_L <br />—L <br />—L <br />_L <br />_O <br />U <br />_ <br />O <br />I S I <br />jI 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 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 />CONTRACTORS LAW 18.27 RCW.AND 296/_60 WAC. - <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED ;��F3G -Z9 - <br />�rf7l�3 <br />