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1 <br />PEIRMIT APPLICATION <br />47r CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 88201 <br />425-257-8810 —FAX 425-257-8857 <br />SITE ADDRESS <br />PARCEL TAX I.D. N <br />PERMIT M <br />47�8 c tka <br />ouqO il CASO42b <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />..IENANFf/AME— <br />CONTACT NAME PHONE <br />I <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE� <br />PHONE 0� V� <br />PROPOSED USE OF BUILDING <br />Building I--) Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />R Combination FLKJ( Plumbing <br />Alteration <br />Electric <br />TYPE <br />B Demolition Sign <br />(WORK <br />TYPE <br />New <br />H <br />Gas <br />Sprinkler <br />Re eir/Maint. <br />11HJ� <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TA%CODE IS 3705 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />N0. TYPE OF FIXTURE OR REM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A/C — A/HANDLINGUNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />- <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />� <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <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 ORICINACES 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 REGULATIN('a CONSTRUCTION OR 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 RCW AND 296.200 WA <br />Signature of Owner/ContractoriAuthoriz gent ate <br />