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I <br /> �tRMIT APPLICATI N <br /> � ?� ITY OF EVERETT PERMIT SERVICES <br /> � � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-G57-8810- FAX 425-257-8857 <br /> �uJ 3ro -o! ' <br /> SITE ADDRES PARCEL TAX I.D.�F P MIT# <br /> • ' o0 6 0 0 � n3�o -bd3 <br /> �GA LOTN . BLOCK TRACT <br /> DESC. a. <br /> OWNER ADDRESS ZIP PHONE <br /> �y� . d � r_ .� ee�� • �� <br /> TENANT E � i CONTACTFORPERMIT PHONE <br /> s r� � <br /> CON TOR ADDRESS ZIP CONTR.LICENSEN <br /> PHONE Sa� C <br /> PROPOSED USE OF BUILDING BUilding I"") MBchanical Additlon HEAT SOURCE <br /> � PERMIT R�( Combination F_� Plumbing WORK � Alterauon D ElecVic <br /> ��O � TYpE u Demolition lJ Sign TYPE New g Gas <br /> U Sprinkler Repair/Maint. Ofher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION ���� S� ��I��I �� <br /> � �• ` <br /> LU 61 MECHANICAL <br /> NO. TYPE OF FIXTURE 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 UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LP.UNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERV�CE/BAR/MOPIETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HERc81'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 VIOLA'fE OR CANCEL TNE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OW NER OF THIS F4�ERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT T S �9.27 RCW AND 296.200 WAC. � <br /> • ' <br /> Sig tu o O n ra /A d Age Date � <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />