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i <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 ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT <br />[2�'U6 �fL FttJ�f <br />Zaoy'i000go6?�7 <br />�V# <br />>�D-I—�y <br />LEGA LOT NO. BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />1� 1"A,5 Y61- P• o r3>x �12I2 ► �p,2Ttswti7 ciZ `t l Z 42 <br />TENANT NAME <br />CONTACT FOR PERMIT I PHONE <br />130vAa13 Zab � 2 3 12Z <br />CONTRACTOR 1 J6� q,� T ADDRESS ZIP CONTR. LICENSE a <br />PHONE yJP.>1'fjL� JQSr^�J'pq311QS <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Building Mechanical <br />Combination <br />tdpign <br />WORK <br />Addition <br />Alteration <br />HEAT SOURCE <br />Electric <br />TYPE <br />IR-(Plumbing <br />Demolition <br />TYPE <br />New <br />Gas <br />Sprinkler <br />Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK 2��•� r <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO.. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />_ <br />A/C — A/HANDLING UNITS <br />_ <br />BATHTUB <br />_ <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />_ <br />SHOWER <br />_ <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />_ <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />_ <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACEISTOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />_ <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <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 LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCS,6ND 296.200 WAC. <br />�� '�? • pb <br />Signature of Own ontra r/Authod ed Agen Date I/ <br />Z <br />EB & CREDIT CARDS ARE NOT ACCEPTED <br />