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( <br /> P 'RMIT APPLICATION <br /> CITY OF EVERETT P'ERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS �}• I O� PARCEL TAX I.D.# PERMIi a <br /> � 1 �I �l U1L ' ' 00 S ��( 1 0 l O O Xo 0 - C� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> vVl alZttu�'IZ�Q.�ov� Tu�c��tw�ec�i }'�ox �nc� ,r,h�,��l: �.z� qi ��zc_ �3u�sv�s <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR AUURESS ZIP CONTR.LICENSE n <br /> PHONE <br /> PROPOSED USE OF BUILDING Building III��� MeChanical Addition HEAT SOURCE <br /> PERMI7 g Combination I� Plumbing WORK R Alteration � Electric <br /> TYPE D Demolition � Sign IYFE � New Gas <br /> U Sprinkle� Repair/Maint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. . TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCEU AIR SYSTEMS <br /> � LAVATORY(WASH DASIN) HEAT PUMP <br /> SHOWER UNITHEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISH�NASHER R,4NGE HOOD <br /> _ LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACElSTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I <br /> I HEReBY CERITIFY THAT I h.4VE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF IAWS 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 PRO!�ISION OF ANY OTHER . <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM A�iHORIZED BY THE I <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAD[AND I COMPLY WITH THE STATE i <br /> CONTRACTORS W 18.27 RCW AND 296.200 WAC. '�, <br /> �FI�I // !� S �`l S'�U�l I <br /> Signature of wnedContractodAuthor(zed Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED I <br />