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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 4?5-257-8857 <br /> SITE ADDRESSPARCEL TAX I.D. # FETIT# <br /> 3 '-7,C--" l -w Er oa '7Z 7 - o —00.2.— o /Z G <br /> LEGAL LOT NO BLOCK TRACT <br /> L <br /> DESC. at �- <br /> OWNER ADDRESS ZIP PHONE <br /> AJ,'-rAtle SP.z�. UE. /4 S* St . key , 4'A. 'I"F, 42t. ?925,37 <br /> TENANT NAME l� I CONTACT FOR PERMIT PHONE <br /> CONTRACT / y ADDRESS r ZIP CONTR.LICENSE# <br /> h1 Gnl«Pr,'r� L�- 6C2.?" A) (f /'FS ` S76EL <br /> PHONE 'J <br /> PHONE <br /> PROPOSED USE OF BUILDING �I rDemolition <br /> uilding M9chanical I I""� Addition HEAT SOURCE <br /> (, s•„�� �N,,,,� PERMIT ombination Plumbing WORK IIIF--J((( AlteElectnc <br /> TYPE Si n TYPE New Gas <br /> prinkler RepaiUMalnt. Other <br /> CONTRACT PRICE OF WORK CITY OF EVr.RETT LOCAL SALES TAX CODE IS 7105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> j_ WATER CLOSET (TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> to�_ LAVATORY (WASH BASIN) HEAT PUMP <br /> 2 SHOWER UNIT HEATERS <br /> L KITCHEN SINK 8 DISPOSAL 1. CLOTHES DRYER <br /> Z DISHWASHER t RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> 1 CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER ,3 GAS PIPING <br /> _ SINK (SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER_ 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 ORIDINACFS GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT D� :S 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 296.200 WAC. <br /> Signature of Owner/Contractor/Authorized Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />