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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, INA 98201 <br /> 425-257-e810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 316 ret-4 sf se _a . ?F2,3 04"A717- coo - o36 - o5-I 0030_ <br /> LEGA LOT N—O. BLOCK TRACT �7 <br /> DESC. —� <br /> OWNER pp p 'T ADDRESS ZIP PHONE <br /> N I III �.��Lr ,n(r l o• L� .Ti <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> F4,1 <br /> PHONE <br /> PROPOSED USE OF BUILDING Building MechanicalAddition HEAT SOURCE <br /> PERMIT �R( Combination I.R.[ Plumbing WORK Alteration Electric <br /> 5F TYPE u Demolition LJ Sign TYPE New I Gas <br /> LJ Sprinkler P Repair/Maint. Other <br /> CONTRACT PRICE OF WORK {/1 ` ,{'(� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION .•//LL�� V <br /> *ew SFR h � r •yla�7'oe dw.' �f se// eN SpeG . � aS`i^ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> fI- BATHTUB FORCED AIR SYSTEMS <br /> L- LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _(_ CLOTHES DRYER <br /> DISHWASHER _/_ RANGE HOOD <br /> LAUNDRYTRAY - WATER HEATLR <br /> I CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN I GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER 3 GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER 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 CAL W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNE HIS P )PERT TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT 1),27 RCW AND 296.200 WAC, <br /> 1(2123 <br /> Signature o e ontractor/Authorized Agent Date �L <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />