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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CLDAR STREET,•EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />I _ <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DES C. <br />OWNER ADDRESS ZIP PHONE <br />TENANT NAME <br />A <br />CONTACT NAME PHONE <br />CONTRACTOR ADDRESS ••. ZIP CONTR. LICENSE # <br />QTNODD '1�I0D 125+,+ Ax s . q$lo$ `iz1400>*CV4i-- <br />PHONE <br />2Qo---721 n-Cxi b <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building 19S Mechanical <br />Combination IIL—`J(( Plumbing <br />WORK <br />Addition <br />Alteration <br />4Repair/Miint. <br />HEAT SOURCE <br />�j Electric <br />TYPE <br />Demolition Sign <br />TYPE <br />Now <br />Gas <br />Sprinkler <br />l <br />Other <br />CONTRACT PRICE OF WORK $1hr-Y� ,�r>"l <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />ZAbta,11 M-3m -Pre Sc�yst �, SIISaeM . <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOiET <br />A/C — AIHANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER &e- 5? <br />I 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 AUTHORED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATI- <br />C TRACTORS L�827W AND 296.200 WAC. <br />�I i sti3 <br />ature of Owner/Cunt Tt /Authorized Agent Date (� <br />