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, <br />PERMIT APPLICATION - <br />-�.... PEflMIT APPLICATION - <br />��CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERE_TT, WA 982r;, 42:-257-6810 <br />/fr/'�-I �qo fti� <br />o'1-cr- <br />PARCE:. TAX I.D. N r �a ! c�N �� <br />PERMIT # <br />SITE ADDRESS <br />P��r��NoF iq;r <br />���t1lLz_ <br />0°S63z.?IDr <br />-UQS <br />LEGAL <br />DESC. <br />LOT NO. <br />BLOCK <br />TRACT ( E ���!- �� -0 I <br />I l� G((o�9'3 <br />OWNER � ADDRESS <br />� PHONE <br />f� <br />�(If LSL /LFJ-O <br />TENANT NAME I CONTACT NAME <br />I PHONE <br />CONTRACTOR��/�L�,¢y; Gor31� ! <br />ADDRESS <br />I CONTR. LICENSE 8 <br />�( <br />13 1-F� <br />r-.�L6.¢C�Y' 23ou/� <br />PHONE �) tS` <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building n Mechanical <br />f� Combination Plumbing <br />WORK <br />Addition <br />� Alteration <br />HEAT SOURCE <br />Elec::ic <br />TYPE <br />B Demolition Sign <br />TYPE <br />New <br />Gas <br />� <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. I <br />TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />� <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEA "ERS <br />I, -KITCHEN <br />SINK 8 DISPOSAL <br />'t- <br />CLOTHES DRYER <br />L <br />DISHWA;,HER <br />RANGE HOOD <br />LAUNDRY TRAY <br />'V <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />_ <br />FLOOR DRAIN <br />BACKFLOW PREVENT.ER <br />� <br />GAS RANGE <br />GAS PIPING <br />_ <br />SINK (SERVICEiBAR/MOPJETC.) <br />EXHAUST FAN <br />_ <br />OTHER _ <br />OTHER <br />I HEPEBY CEPITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANC 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 PERM' DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGUW:ONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TC � ']RM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 16.27 RC. 196.200 WAC. <br />Signature of Owner/Contractor/Authonz°d Agenl Date 1 t'., 1 <br />