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PLRMIT APPLICATIC A <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. M <br />PVMIT w <br />GOI '7y7r ST S1= <br />>1-3S7n—C71�—Wq—off <br />6� —00 <br />LEGA LOT N0. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />T)/Lc/2 K oir!50 ' JO Fox 37/0 7c?3 e/zSsaI?6S5',� <br />TENANT NAME <br />CONTACT NAME PHONE <br />—_— I <br />CONTRACTOR ADDRE 'f 7 / r. / ZIP CONTR. LICENSE M <br />t C'[ S��/F.Ct.9✓,a ire/[. �c l�'o x <br />O ! Snnl S'Fzo 3 O[S(�n/P/�-t 5'4.iF <br />PHONE <br />PROPOSED USE OF BUILDING <br />Building Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />I <br />P'molition Combination ILJ( Plumhng <br />WORK <br />Alteration <br />I� Electric <br />TYPE <br />Q�Slgn <br />TYPE <br />New <br />N <br />I ILH'J� Ous <br />Sprinkler <br />Repair/Mani <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION ' r)L,/le d-i rf chi <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />I <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />A/C - A/HANDLINGUNITS <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 & DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACEISTOVE <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 />_ <br />SINK (SERVICE/EIAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER <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 />CONTRACTORS LAW 18.27 RCW AND 298.200 WAC. <br />,cam ;�^ i✓_-!.>✓�� �� - 7 -0� <br />Signature of wner/ ontractor/Authonzed Agent Date <br />