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PERMIT APPLICATION <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 />.}120 NosSct,u SAY-,c-f- <br />PARCEL TAX I.D. # <br />001-13-15- -6zS-azbo <br />PERMIT # <br />Bcti3UC�p�{� <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />` l_1 <br />Z <br />t 1� <br />OWNER AD R SS ZIP PHONE <br />IZU QSfpj-! Sf WO -7910 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />7 pp <br />�� I �LC tub C.I\ qZG -ZSZ— O79 CD <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />/ \ � <br />PHONE <br />PROPOSED USE OF BUILDING <br />1U, <br />Building Ii Mechanical <br />ILL---J(( <br />Addition <br />HEAT SOURCE <br />PERMIT <br />Combination Plumbing <br />WORK <br />Alteration <br />N <br />Electdc <br />��— <br />IYKU-11 <br />TYPE <br />Demolition Sign <br />TYPE <br />New <br />Gas <br />D <br />Sprinkler <br />RepairlMaint. <br />Other <br />CONTRACT PRICE OF WORK I q7 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUM81 G <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />_ <br />A/C—A/HANDLING UNITS <br />_ <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />_ <br />SHOWER <br />_ <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />_ <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />_ <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />_ <br />METAL FIREPLACE;STOVE- <br />_ <br />URINAL <br />_ <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />_ <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />_ <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />_ <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_ <br />EXHAUST FAN <br />_ <br />OTHER <br />OTHER <br />CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />I HEREBY <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 296.200 WAC. <br />(0 0�1 <br />Signature of Owner/Contractor/Authorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />