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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-2E7-8810 —FAX 425-257-8857 <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />�j[, <br />i' w F C o 30 7-DPI f <br />LEGAL] LOT NO. BLOCK TRACT <br />DESC. <br />OWNER � ADDRESS A L S ' ZIP PHONE <br />-. <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />PHONE St/! G�._p <br />PROPOSED USE OF BUILDING <br />BuildingMechanicalAdditionHEATSOURCE <br />PERMIT <br />I <br />Combination � plumbing <br />P <br />WORK <br />Alteration <br />I� Electric <br />TYPE <br />Demolition Sign <br />TYPE <br />New <br />B Gas <br />I <br />Sprinkler <br />Repair/Maim. <br />Other <br />CONTRACT PRICE OF WORK S �' e,w ` <br />, <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />WORK DESCRIPTION .� <br />/ <br />PLUMBING <br />MECHANICAL <br />N0. 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 />� <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />,L <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUIJTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />_L <br />GAS PIPING <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 GRAr TING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITI' TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER � <br />STATE OR LOCf.L LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHOPIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />C ACTORSORS LAW AND 296.200 WAC. <br />r I <br />Signature Or Owner/ontractorlAuthonzed Agent Date <br />r <br />C/2-) <br />