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� <br />: <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE AODRESS <br />�. � � ,�.1 `7L .ScJ <br />LEGA LOT N0. BLOCK <br />DESC. � % <br />OWNER <br />�,� t . i��n ir� IJe%ra1 <br />TENANTNAME <br />PARi.EL TAX I.D. p <br />c: r� h�- <br />COpiTACT NAME <br />a <br />ZIP PHONE <br />r� C,:eref� `)$ZLU �����3'/�C, �t� <br />PFiONE <br />- � ;�,�2 rJ�l�w, � Czc�. � � -- �-��, �- <br />CONTRACTOR � ADDRESS ZIP CONTR. LICENSE 8 I <br />(�Ll?1�K? 1� � <br />PHONE <br />PROPOSE� USE OF BUILDING <br />���� <br />CONTRACT PRICE OF WORK <br />' • ' ': l c <br />Buildirg 1Aechanical <br />PERMi7 � Combinal�on � Plumbing <br />TYPE Demolilion Sian <br />Sprinkler (a of headsj <br />L�i�-� <br />WORKDESCRIPTION jj`I,�,1���,' <br />i� <br />�n.�e.� 1� I-,,,Ifar_ j,;o <br />NO. I TYPE OF FIXTURE OR ITEM <br />� WATER CLOSET (TOILET) <br />BATHTUB <br />�_ LAVP.TORY (WASH BASIN) <br />� SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />2ACKFLOW PREVENTER <br />� SINK(SERVICE/BAR/MOP/Ef�.) <br />OTHER <br />� <br />Addition <br />Alteration <br />New <br />Repair/Maint. <br />HEATSOUHCE <br />Eleciric <br />Gas <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I���� � ����. <br />io o�r;�.ii� <br />%i_ b�il. i �,,� ^ �.`C,.� <br />P,^�T�'��f I I.11 <br />MECHANICAL <br />NO. I TYPE OF FIl(TURE OR ITEM <br />A/C — A/HANDLlNG UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />f�IREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXhAUSTFAN <br />OTHEH <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TPUE AND CORFECT. ALL <br />PROVISIONS OF LA1NS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHF.THER SF'ECIFIED HE:REIN OR <br />NOT. THL G�?ANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHURITY TO VIULATE OR CANCEL THE PROVISION OF AWY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED EY THE <br />OWNFR OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 1827 RC'JJ AND 296200 WAC. <br />�� � <br />.1"�'����� � �r.��l�--- 1/-Oy-O� <br />Sign�(ure of Owner oniractc dAuthonzed Agern Date ^ <br />`/Z/ <br />