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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857 l p <br /> SITE ADDRESS PARCEL TAX I.D.# PE IT p <br /> 130 -sq T 5.U.s I <br /> LEGA. LOT NO. BLOCK TRACT <br /> DESC <br /> OWNER ADDRESS �4bC�4 �Z�Q a ZIP PHONE <br /> c\ 1\ LLC 66kk%k 4$01 (AJ'i— 1/l3'tlll <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> -e ss IQ�1 4 ds- -1y3- 1119 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> 17b39. 3 at,�Sf 6Jo`f(kell WAC g4sot7. <br /> PHONE �DQtR�t-c� ,te-I <br /> yM; --743-1'll� _ <br /> PROPOSED USE OF BUILDING Building rYMechanical Addition HEAT SOURCE <br /> PERMIT Combination lambing WORK LR.( Alteration Electric <br /> TYPE �E eemolitian Si (TYPE heP �as <br /> S dnkler U Re air/Mainz I Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> — WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> ; _ BATHTUB FORCED AIR SYSTEMS <br /> H LAVATORY(WASH BASIN) HEAT PUMP <br /> -k SHOWER UNIT HEATERS <br /> 1 KITCHLN SINK 8 DISPOSAL CLOTHES DRYER <br /> _L DISHWASHER _L RANGE HeeD M,tQo <br /> _ LAUNDRY TRAY I WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN �_ GAS FIREPLACE <br /> FLOOR DRAIN _L GAS RANGE <br /> BACKFLOW PREVENTER 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 /> Sl ArE 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 1 COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> --r <br /> Signature f Owner/ ontractor/Aut rued Agent ate <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED ' ?j <br />