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PitRMIT 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 I PARCEL TAX I.D. # <br />L oo0 l X- S� <br />PERMIT # <br />I <br />' le <br />a03dG-036 <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />D'cSC. <br />OWNER ADDRESS ZIP PHONE <br />s 7 7n <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />I <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />PHONE C)von (— <br />PROPOSED USE OF BUILDING <br />I <br />PERMIT <br />Building Mechanical <br />R Combination R ng <br />WORK <br />I� Addition <br />[� Alteration <br />HEAT SOURCE <br />Electric <br />)py7/ <br />TYPE <br />B Demolition D Si n <br />Sigr <br />TYPE <br />8 New <br />Gas <br />Sprinkler <br />Reoair/Maint. <br />Other <br />CONTRACT PRICE OF WORK <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 />— <br />WATER CLOSET (TOILET) <br />C—A/HANDLING UNITS <br />A/FORCED <br />— <br />BATHTUB <br />AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <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 />GAS PIPING <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 REGUL'TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OFT IS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRA T SLAW 1 .2 RCW AND 296.200 WAC. <br />Sig ure of Owner/C rartn/A thonzed Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />