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PERMIT APPLICATION <br />�4= CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />s - � - � 1�lafel&7 r—w �-17?� <br />SITE ADDRESS <br />PARCEL TAX I.D. # P,JArruoF 0t' <br />PERMIT # <br />PDi-T,o,., Of ! <br />oo-�-c 9 L? SGOQ t o e <br />LEGALI <br />CT <br />DESC. <br />I <br />T !Ciro -Ana TO FL/ -.A- -Fr Oa-u I <br />OWNER <br />ADDRESS (PHONE <br />Lrit�nfir�Eh- p/�t�/Sy <br />L�3�Kt(<ft.�tic ez( 2fL-�ySo <br />TENANTNAME <br />CONTACT NAME PHONE <br />CONTRACTOR l✓q L/3,gcW &q,f j, <br />ADDRESS I CONTR. LICENSE # <br />PHONE y L) - Lf L -9<rfo j <br />L l 3t /Yt(-{� ' ��jC �l,%, N/,f L/.I✓d« 2i Gv�/ <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />Combination jDj Plumbing <br />WORK <br />Alteration <br />N <br />[j Electric <br />TYPE <br />Demolition Sign <br />H <br />TYPE <br />New <br />B Gas <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A/C - A/HANDLING UNITS <br />BATHTUB <br />1- FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />_ HEAT PUMP <br />SHOWER <br />_ UNIT HEATERS <br />KITCHEN SINK & DISPOSAL <br />1 CLOTHES DRYER <br />_ <br />L DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />_ Z WATER HEATER <br />I- CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />'+� <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICEBAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER <br />OTHER_ <br />I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLIC AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING <br />THIS TYPE 0 < WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVEN.:' JRITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PER. - LANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER JF THIS PROPERTY TO PERFORM THE WORK FOR WHICH Ar,PLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND296.200 WAC. <br />&, '7�41 <br />01 <br />Signature of Owner,Contractor/Authanzed Agent <br />Date <br />1/Z <br />