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i ERMIT APPLICAT, JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-5810 — FAX 425-257-8857 (. 11(,-D Z� <br />SITE ADDRESS <br />PARCEL TAX I.D. It <br />PERMIT a <br />-2 CLOT <br />LEGA LOTNO. <br />BLOCK TRACT <br />DESC. 19 <br />OWNER <br />ADDRESS <br />ZIP PHONE <br />TENANT NAME <br />CONTACT NAME <br />PHONE <br />-a4N1e <br />1 /:14L- <br />215Z-0¢7/ <br />CONTRACTOR <br />ADDRESS <br />ZIP CONTR. LICENSE 0 <br />PHONE <br />PROPOSED USE OF BUILDING <br />MechanicPERMIT Combination <br />Plumbing <br />WORK <br />HEARSE eRCE <br />TYPE <br />Demolition U Sig;. <br />v <br />TYPE <br />IILL.....�,(( New <br />I--( gtlea <br />u Gas <br />��� <br />Sprinkler <br />r/Nairn <br />IJ Other <br />CONTRACT PRICE OF WORK <br />/ 191 0,7 �f <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />41 G�1�'- <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />—7— <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLCW PREVENTER <br />SINK (SERVICE✓BAR/MOP/ETC.) <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />A/C - A/HANDLINGUNITS <br />FORCED AIR SYSTEMS i, <br />HEAT PUMP - <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I <br />_ I <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <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 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 WAC. <br />Signature of Owner/Contractor/Authorized Agent Date <br />