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PERMIT APPLICATION <br />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 PARCEL TAX I.D. # PERMIT tt <br />/ 90S WAc,vui S i OOS/a 3 Z 39sa/3c� dcs3or� _�� <br />LEGA LOT NO. BLOCK TRACT <br />Desc. 3 yj 5,4JNT N/LHOLldS JftlairiuN <br />OWNER ADDRESS ZIP PHONE <br />�AN//JL M .SAKl7ln/ Sl4inc 9b2o1 (yLs)ZSfI-y'!/!v <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS 21P CONTR. LICENSE ar <br />PHONE <br />PROPOSEDU�UILDINGpERM1TSpnnklleationPlumbingalWORK <br />TYPEDemolitionSign <br />TYPE <br />New <br />N <br />(!Q Gas <br />Repair/MaimHEA7SEe�E <br />U Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />WORK DESCRIPTION p av,M/+ C✓i � SO�%Ui'�I Uf fJG'U}C RE O�U.uG `KAUiNb i�li C� JZC't'�' <br />..:N�25r.,, <br />PLUMBING <br />MECHANICAL <br />� w <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A/C—A/HANDLING UNITS <br />BATHTUB <br />_FORCED <br />AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />_HEAT <br />PUMP <br />SHOWER <br />_UNIT <br />HEATERS I <br />_ <br />KITCHEN SINK &DISPOSAL � <br />_CLOTHES <br />DRYER <br />�I <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />_ <br />URINAL <br />_FIREPLACE <br />INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />_GAS <br />RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER <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 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 OF 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 />CONTRACTORS LAW 18.27 RqCW 296.200 WAC. <br />�AD ] <br />Signature of Owner/Contracto Authorized Agent Date <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />