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_ -- - i <br /> j PEr2MIT APPLIGATIO�J <br /> ' CITY OF EVERETT PERMIT SERVICES 5-/o-D � <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 i <br /> 425-257-8810 - FAX 425-257-8857 ��� �/ <br /> SITE ADDRESS PARCEL TAX I.D.# PERtitiT� /i <br /> �_ < , ., ,� � � ' Moyo5-d� <br /> LEGA LOTNO. BLOCK � TRACT <br /> DESC. � <br /> OWNER AOORESS 21P PHONE I <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> II <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# I' <br /> PHONE II <br /> I <br /> PROPOSED USE OF Bl11LDING f'� Building f� Mechanical � fl AadOon I HEAT SOURCE i <br /> I PERMIT �� Combination 4_� Plumbing IN'ORK �_� Alteration � ElecNc <br /> TYpE �j Demolition Ll Sign IYPE �l New Gas <br /> L) Sprinkler l.) RepaidMainL Other <br /> CONTRACT PRICE OF WORK CIIY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICA� <br /> ryp. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM i <br /> VJATER CLOSET(T0;!.ET) _ A/C—A/HANDLING UNITS <br /> 6ATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER � UNITHEATERS I <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER I <br /> DISHWASHER _ RANGE HOOD <br /> LAU�:�RY TRAY _ WATER HEATER <br /> CWTHcS WASHER _ YIETAL FIREPLACE/STOVE I <br /> URINAL FIREPLACE INSERT I <br /> I _ DRINKWG FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DR41N GAS RANGE � <br /> ' Bp.CKFLOW PREVENTER � GAS PIPING <br /> SINK(S[RVICGBAR/MOPIETC.) _ EXHAUST FAN <br /> OTHER _ UTHER _ <br /> _I — — — _ <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAAIINEC TNiS APPLICA710N AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL <br /> PROVISIC VS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF bVCRK 64'ILL BE COMPLIED VJITH WHETHER SPECiFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PR[SUME TO GIVE AUTHORIN TO VIOLATE OR CAIJCEL THE PROVISI04 OF ANV OTHER <br /> STATE OR LOCAL LAVJ REGUTATING CONSTRUCTION OR THE PERFORNANCE OF CONS7RUCTIGN. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRO°ERTV TO PERFORId THE WORK FOR\NHICH APPLICATION IS IdADE AND I COMPLY 1VITH THE ST�TE <br /> �. CONTRACTORS LAW 18.27 RCLN AND 2P6.200 WAC. ' <br /> � �ture of Own�tr rectodAuthorize:l Agent Date �. <br /> � <br /> � DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />