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PaRMIT 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. 9 <br />PERMIT # <br />7 ;"I C C'Cc� 1 UDOG'CJv <br />LEGAL] LOT NO, BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS 5•�ZIP PHONE <br />V &Pu- I Iri ie c-0 13,R5 '7Y7y ��7 <br />TENANT NAME I <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />I"(I?II- WtcuI4&)rcr)�,1AX. <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />Bulltlinp �Mechanlcal <br />Combinallon plumbing <br />Ad"'on <br />WORK Alteration <br />HEAT SOURCE <br />�Elactnc <br />C 1� <br />TYPE <br />-•(t <br />Demolition S,)n <br />P <br />TYPE ew11 <br />I <br />Sprinkler <br />RepalrrMalnt. <br />Other <br />CONTRACT PRICE OF WORK r� '7 w�� <br />OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />((CC�ITY <br />WORK DESCRIPTION &1) S .i LPf1 j-N rZA1/9CL_ ICE t�1416L ttl,/k) <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET (TOILET) <br />A/C—A(HANDLING UNITS <br />BATHTUB <br />J_ <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK & DISPOSAL <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 />_ <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER <br />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 />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO P FORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW,1 S. ► RC A D 298.200 WAC. <br />Signalur 'o r/ontra r/Authonzed Agent Dal <br />kC��IIJGi)T/�', C Ji /4tv�CCC��, <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />