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I — — <br /> 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 PARCEL TAX I.D.# P RMIT# <br /> I IL4 7' f h P L 5 Cid E i r7- u 00 7010 000 01 <br /> LEGALI LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> AvI� kLl _? �`` � L <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> )q\) 10 "/ cE—�— ZS` 3S3 <br /> CONTRACTOR ow , ^ ADDRESS ZIP CONTR.LICENSE# <br /> PHONEPROPOSED USE USE OF BUILDING Building D Mechanical Addition HEAT SOURCE <br /> �r..Tr cof-n ! RQ.4&iE PERMIT Demolition U Plumbing WORK R Alteration Electric <br /> L t� 7 U tl C� TYPE Demolition U Sign TYPE B New Gas <br /> Sprinkler RepairlMaint. Other <br /> CONTRACT PRICE OF WORK R Zz CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> �ETffiG+ikL �) Gpf C, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER 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 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 /> OWNETHIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT CT RS LAW 10.27 RCW AND 296.200 WAC, <br /> 4y- 3,9 , oy <br /> Signature ut Owner/Contractor/Authonzed Agent Date <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED I Z <br />