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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 <br /> SITE ADDRESS PARCEL TAX I.D.N P MIT p <br /> LEGZF LOT NO. BLOCK TRACT <br /> DESC. I7 <br /> OWNER ADDRESS ZIP PHONE <br /> a,�0-i2 t *a-,N ! � •1-C „ u-51' EE "A 15 --1` -6- 1-1 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> 0Att.t9- C--���s�� t"1c,�a-35�i-Iv�SE q�o�� A�AIRELoaac <br /> PHONE <br /> PROPOSED USE OF BUILDING I fornbin'ation <br /> Udinf']�Mechanical Addition HEAT SOURCE <br /> PERMIT II L--xIt�Plgumbing WORK Alteration I7 Electric <br /> TYPE emolition SI n TYPE ow as <br /> prinkler RepalrlMalnt. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> W` \ORK DESCRIPTION <br /> heli.) wzkL <br /> �.1 PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. I TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB T FORCED AIR SYSTEMS <br /> LAVATORY LWASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> I KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> I DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY I WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN I GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) 4 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 uORRECT. 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 RCW AND 290.200 WAC. <br /> � a9�- ql� ISj04 <br /> Signaftfre of Owner! ontract� uthorized Agent Date r <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED Z <br />