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425-257-88 1 0 -FAX 425-257-8857 y ` I -�'- --O v <br />I <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />gTRMIT # <br />� <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />.7-� � (� �"✓Lr c2 �//lam S%� � � 7��_U/ /ZS �Z:� <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building I-1 Mechanical <br />Combination Plumbing <br />Addition <br />WORK Mteration <br />HEAT SOURCE <br />Electric <br />TYPE <br />u Demolil:on Sign <br />TYPE Ne•.v <br />� Gas <br />Sprinkler <br />I RepairlMaint. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />-- <br />WATER CLOSET (TOILET) <br />A/C — A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />) � <br />SHOWER <br />UNIT HEATERS <br />KITCHEIJ SINK 8 DISPOSAL <br />_CLOTHES <br />DRYER <br />_ <br />DISIiWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOI i1E5 WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FO:INTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIIJ <br />GAS RANGE <br />_ <br />BACKFLOW PRE,/ENTER <br />GAS PIPING <br />SINK (SERVICE/BAFt'MOP/ETC.) <br />l� <br />EXHAUST FAN <br />_ <br />OTHER _ <br />OTHER <br />I HEREBY CERTIFY 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 IS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMELY WITH THE STATE <br />CONTRA RS LAW �8.27 WAND 296.200 WAC. <br />Ign ture of OwnerlContractorlAuthorized Agent ate <br />DEBIT $CREDIT CARDS ARE NOT ACCEPTED <br />HERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />