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i-ERMIT APPLICATON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT W,A 98201 <br />425-257-8810 — FAX 425-257-8851 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />PA00L(-DL <br />.3`ilb` I <br />cOpp/ / / 4aQ, <br />_ <br />LEGA LOT N0. <br />BLOCK <br />TRACT u a <br />OWNER' <br />"n <br />t ullZrot <br />Ac-t-id <br />L ADDRESS ZIP PHONE <br />�J418' Roc�Of �J�M �✓C/P 11 ((�Pl Z� '/ <br />TENANT NAME <br />CONTACT FOR PERMIT PHCVE <br />CONTRACTOR <br />ADDRESS ZIP CONTR. LICENSE # <br />PHONE )j/"",`,-/) <br />PROPCSED USE OF BUILDING <br />j� <br />PERMIT <br />Building lof Mechanical <br />R Combination IYL-'{J( Plumbing <br />WORK <br />Addition <br />Alteration <br />HEAT SOURCE <br />j� Electric <br />S <br />TYPE <br />B Demolition Sign <br />TYPE <br />New <br />� <br />FL�'J(S Gas <br />J�� <br />1 <br />Sprinkler <br />repair/Mainz. <br />Other <br />CONTRACT PRICE OF <br />WORK V J5 0C) <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />I�4pal1rlrP?lace <br />hC'(J ducf, 905 vafve) ad I'It►/a/( <br />ck�vme� <br />livief <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM. <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICEiBAR/MOP/ETC.) <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />__ <br />_ <br />_ <br />A/C-NHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS P.ANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <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 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 />CONTRACTOFS LAW 18.27 RCW AND 296.200 WAC. i <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />