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1-cRMIT APPLICATIJN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 —FAX 425-257-8857 <br />SITE ADDRESS r <br />PARCEL TAX I.D. S <br />PERMIT a <br />L GA LOT N0. BLOCK <br />TRACT <br />D. ESC <br />OWNER ADDRESS ZIP PHONE <br />TENANT NAH.` <br />Cq N,T�r FOR PHONE <br />t,1L�ERMIT <br />u2C� �F2-� 8�� 3g2U <br />CONTRACTOR SS <br />n r��pp�Q�� � ZIP CONTR. LICENSE N <br />!C)I'f <br />�I E � <br />PHON`E/ <br />�1XIN��JVI� � Ir'� W073 PIED 1S� <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building Mechanical <br />CombinationPlumbingWORKAlterationElectric <br />[[[]]] Addition <br />HEAT SOURCE <br />TYPE <br />Demolition Sign <br />N <br />TYPE New <br />Gas <br />I�S i <br />Sprinkler <br />Repair/Maim. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 31 C6 <br />WORK DESCRIPTI N <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR REM <br />WATER CLOSET <br />A/C—AJHANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK &DISPOSAL <br />_CLOTHES <br />DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIfJ <br />GAS RANGE <br />BACKFLOW PREVENTER <br />� <br />GAS PIPING <br />_ <br />I � <br />SINK (SERVICE/�%R/pctOR/ETC.) <br />EXHAUST FAN <br />� <br />OTHER p/,,^O rNK <br />OTHER <br />' I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINA OVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT OES T PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW LATI CONST UCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS ROP RTY F RFORM E WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />� <br />C CTORS IN 1 27 RCS D 296.2 1NAC. <br />r_ <br />Signa f /C nir r� utl r d Agent D to <br />� DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br />