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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 <br />PARCEL TAX I.D. p <br />PERMIT # <br />LEGA L�T N09 <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />,v,�4oi« ?o. adX C-yy ;�Wr 47- yos-580-ogss <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />yKht 'C <br />CONTRACTOR ADDRESS 21P CONTR. LICENSE N <br />PHONE <br />ly <br />PROPOSED USE OF BUILDING <br />n Building Mechanical <br />HEATSOURCE <br />TYPEITDemoltiononSlgnbing�,PERePalrl/Malnt.Gh�cSprinkler <br />� <br />WORK <br />HAdllion <br />CONTR CT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7703 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />N0. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A/C — A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />_ <br />_ <br />DISHWASHER <br />RANGE HOOD <br />+ 2Qd��f <br />LAUNDRY TRAY <br />x <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 />CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />I HEREBY <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 />SLATE 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 16.27 RC'N AND 296.200 WAC. <br />Signature o ner/ ontractor/AulhonzedAgent Dale <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />