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PERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 <br /> [DES <br /> ADDRESS ,,../ PARCEL TAX I.D.# PERMIT a <br /> cI �— MD310-DZ3 <br /> L LO't 110. BLOCK TRACT <br /> ER ADDRESS ZIP PHONE <br /> TENANT NAME I ONTACT FOR PERMIT PHONE <br /> CONI RACTOR ADDRESS ZIP CONTR.LICENSE# <br /> /??<. 0CGir(JSi/Z✓ OA-1 <br /> PH'JNE AJ I`Eir <br /> P/ROPOSED USE OF B/UILy�ING Building Mechanical Additiuo HEAT SOURCE <br /> i m /'/rrvf z� I PERMIT R Combination R Plumbing WORK R Alteration (� Electric <br /> .� TYPE B Demolition D Sign (TYPE B New I B Gas <br /> >j,yrJ-r Sprinkler Repair Maim. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> /r✓:S,i1rc L j/l'S !-u/st.i=i�' r rt,—ic=� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER V GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) _Y_' EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CE RITIFY 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 /> CONT: TORS LAW 18.27 RCW ND 298.20U WAC. <br /> Signature of Ownelip6rilractorl themed Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />