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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 <br />PARCEL TAX I.D. # <br />PERMIT # <br />'3 U 4i,41 <br />B C)3 a� Gi Sr <br />LEGAL LOT NO. <br />BLOCK TRACT <br />DESC. <br />OWNER ADDRESSZIP PHONE <br />GM201 - 3 <br />TENANT NAME T CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS I70VV ZIP CONTR. LICENSE# <br />PHONE ._ovvc, <br />PROPOSED USE OF BUILDING <br />li <br />Building I--) Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />Combination 11-U-t( Plumbing <br />WORK <br />Alteration <br />Electric <br />1� — I? <br />5 <br />II�/ <br />TYPE <br />Demolition Sign <br />TYPE <br />New <br />Repair/Maint <br />Gas <br />Other <br />/ ) <br />Sprinkler <br />CONTRACT PRICE OF WORK �p"� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />kr <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/HANDUNG UNITS <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />_ <br />SHOWER <br />_ <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />_ <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />_ _ <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_ <br />EXHAUST FAN <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 />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 N ESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULAT CO CTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZE) BY THE <br />OWNER OF IS PROPER r• THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTO 1 6.200 WAC. <br />Signature of Owner! ent ctor/Authorized Agent Uate <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />