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R cRMIT APPLICATtiN <br />CITY OF EVERETT PERMIT SERVICES <br />32f") CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 -FAX 425-257-8857 <br />SITE ADDRESS I ell'T PARCEL TAX I.D. If PERMIT a <br />o <br />LEGAIJ LOT N0. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />TENANT NA E ONTAC,T{�pp,ME C/ PHONE <br />e <br />ri1 r6: C<•ae- (0. ADDRESS /gp/.5-C�7L4�KS ZIP CONTR. LICENSE# <br />CONTRACTOR �;/Jii 3 <br />PHONE <br />eras-�sG-��� <br />PROPOSED USE OF BUILDING <br />Building 52S Mechanical <br />Addiflon <br />HEAT SOURCE <br />PERMIT <br />TYPE <br />{R( Combination LYHJ( Plumbing <br />u Demolition Sign <br />WORK Alteration <br />TYPE New <br />Electric <br />� Gas <br />Sprinkler of heeds) <br />Repair/Meint. <br />Other <br />(a <br />— <br />—+ <br />CONTRACT PRICE OF WORK (�G coo <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />N0. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR REM <br />_ <br />WATER CLOSET (TOILET) <br />/ <br />A/C — A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />� <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />% A', ER HEATER <br />_ <br />CLOTHES WASHER <br />nJ.EI'AL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />_ <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />� <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />� <br />EXHAUST FAN <br />OTHER <br />OTHER <br />I HEREBY CERITIFV 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 VFW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLI ATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS W 18. 7 R 296.200 WAC. <br />,AND <br />�� <br />Signature of Owner/Contractor/Aut zed Agent Date <br />