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PLAMIT APPLICATICA <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREFT, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRE: S <br />PARCEL TAX I.D. A <br />PERMIT a <br />Y3rt 've <br />cnaca-ot3 <br />LEGAL] LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />TENANT NAME I CON? NAME PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE a <br />PHONE <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />Addition <br />MEAT SOURCE <br />PERMIT <br />R CPmbination Plumbing <br />B Alteration <br />�i Electric <br />TYPE <br />B Demolition Sign <br />(WORK <br />TYPE <br />B New <br />ILJt Gas <br />I <br />Sprinkler <br />Re air/Maint. <br />Other <br />CONTR T Pff CE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />WORK DESCR17P ON <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />A/C — A/HANDLING UNITS <br />_L <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_L <br />KITCHEN SINK 8 DISPOSAL <br />__ <br />CLOTHES DRYER <br />DISHWASHER <br />_L <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />�� <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />__ <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />= <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 GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR AL W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER THIS OPERTY TO PE RM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CO NT CTOR W 18.27 W D 296.200 WAC. <br />gnaiur Sf5 Of Owner roolr r/Aulhonzed Agent Date <br />