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PERMIT APPLICATION <br />4--7r CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425.257-881n <br />SITE ADDRESS PARCEL TAX I.D. N PERMIT N <br />> S*r '< 0S-Z - fz ' �a /G -G2 <br />L GAL <br />LOTNO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER <br />ADDRESS <br />PHONE <br />d,)ha3 <br />?-c9// %Z 5' -5£ ES- <br />3s_ 2'-s'7: 7, <br />TENANT NAME <br />CONTACT NAME <br />PHONE <br />( <br />I <br />CONTRACTOR <br />j ADDRESS <br />CONTR. LICENSE N <br />PHONE <br />—`— <br />PROPOSED USE OF BUILDING <br />�uilding n Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />I) Combination jD} Plumbing <br />WORK <br />Alteratior <br />Electric <br />TYPE <br />Demolition Sign <br />TYPE <br />New <br />N <br />Gas <br />Sprinkler <br />Repair/Maim. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />_ <br />A/C-A/HANDL.ING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />_ <br />SHOWER <br />_ <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <br />_ <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <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 PREVENi_R <br />GAS PIPING <br />_ <br />_ <br />SINK (SERVICEBARIMOP.rETC.) <br />EXHAUST FAN <br />OTHER <br />OTHEP __ <br />1 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 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 />CONTRA LAW' 18.27 RCW AND 296.200 WAC. <br />Signature of Owner/Contractortuthorized Agent Date ly <br />