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s z6�s <br />PERMIT <br />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 — - <br />PARCEL TAX I.D. # I P�jRMIT a <br />� (,�1, C%t5 .No 21J) <br />�J <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />eoel NCi <br />TENANT NAME <br />CONTACT FOR PERMIT , /�S PHONE <br />3Q, S <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE N <br />PHONE <br />PROPOSED USE OF BUILDING <br />rY,,y( Building F"1 Mechanical <br />Addition <br />NEAT SOURCE <br />PERMIT <br />I ) Plum <br />Alteration <br />I� Electric <br />TYPE <br />!{I--J(( <br />Demolition <br />Demolition Sign <br />(WORK <br />TYPE New <br />Gas <br />I <br />II� <br />Sprinkler <br />Re air/Maint. <br />11HJ-1 <br />Other <br />I <br />CONTRACT PRICE OF WORK L�] y v <br />/ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET (TOILET) <br />A/C — A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY tWASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <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 />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <br />ill <br />OTHER _ <br />___ <br />OTHER <br />I HE`2EBY 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 AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CON7 CTORS LAW 1 .27 fjED �9600 WAC. <br />IiJ <br />6t5o <br />Signature of Owner ontractor/Authorized Agent Date t/L <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />