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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS I PARCEL TAX I.D. # PERMIT # <br />3 r2 i ' 3 5 2-3 <br />LEGA LOT NO. BLOCK TRACT <br />DES C. <br />OWNER ADDRESS ZIP PHONE <br />TENANT NAME CONTACT NAME PHONE <br />�dpG�/GL1u 1 i�'S G Sz. z7�l <br />CONTRACTOR ./D ��- i�j,�{� ADDRESS ZIP CONTR. LICENSE # <br />PHONE <br />PROPOSED USE OF BUILDING n BUilding I--1 Mechanical Addition HEAT SOURCE <br />PERMIT IIU-{/(�CCombination IIL---J(( Plumbing WORK R Alteration Electric <br />TYPE emolition Sign TYPE [U�-New Gas <br />Sprinkler (tt of heads) Repair/Maint. Other <br />CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />��oc%s�1 cXi57 Gf/UkeN- <br />rc��57�evcj,�� <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <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 (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />7 <br />/L <br />_ <br />_Z <br />A/C - AIHANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER — e j G`� <br />METAL FIREPLACE/STAVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />`t— <br />_ <br />Z_ <br />_ <br />L <br />_ <br />_ <br />_ <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 G9ANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY O-, HER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR Tf IE 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 />CON�CL LAW 18.27RCW AND 296.200 WAC. <br />1L <br />