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I <br />PERMIT APPLICA) ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. # I PERMIT a <br />P0305-010. <br />s ae <br />LEGA LOT NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />3CnnrFEn UOKC 44Z4 5 lRo AVE 99201 425- ZSZ-Clef <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />SAMF <br />CONTRACTOR MfQ,T MEI.�40'v���` ADDRESS gif,3o Is?,QO pve "C ZIP CONTR. LICENSE <br />MECITM2 163c- ^ <br />QBost <br />PHONE 42S _ <br />yg3-92zM <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building Mechanical <br />lR-( Combination Plumbing <br />WORK <br />(dition <br />rAlf1ration <br />HEAT SOURCE <br />Electric <br />Gas <br />TYPE <br />a Demolition LJ Sign <br />TYPE <br />ew <br />Sprinkler <br />epair/Maint. <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />_ <br />A!C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />1 <br />BATH TUB <br />LAVATORY (WASH BASIN) <br />_ <br />_ <br />HEAT PUMP <br />SHOWER <br />_ <br />UNIT HEATERS <br />KITCHEN SINK & DISPOSAL <br />_ <br />CLOTHES DRYER <br />_L <br />DISHWASHER <br />_ <br />RANGE HOOD <br />_ <br />_ <br />LAUNDRY TRAY <br />_ <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />1 <br />CLOTHES WASHER <br />FIREPLACE INSERT <br />_ <br />URINAL <br />DRINKING FOUNTAIN <br />_ <br />_ <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />_ <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />_ <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAMMOP/ETC.) <br />__ <br />EXHAUST FAN <br />_ <br />OTHER <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 />WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK ER <br />O CANCEL THE ON OF ANY <br />GRANTINGNOT. THE <br />REGULATING CCONSTRUCT ON OR THE PERFORMANCE OF CONSTRUCT ON. THAT I AM AUTHORIZED BY THE <br />STTATE OR LOCALL LAW <br />THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />OWNER OF THIS PROPERTY TO PERFORM <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />s-29 07 <br />Owner/Contractor/Authonzed Agent Date <br />of <br />Signature of <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />