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PERMIT APPLICATION <br />CITY Or EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425.257.8810 - FAX 425-257-8857 <br />l! ko�os-o[9 <br />Sr fE ADDRESS I PARCEL TAX I.D. M PERMIT 0 <br />BLOCK I TRACT <br />OWNER <br />A'D1D1rrRE-S-7S <br />ZIP <br />PHONE <br />TENANT NAME <br />CONTACT NAME <br />PHONE <br />, <br />1 TI LC1 <br />r <br />Ci t D - a*] i � <br />ONTRAC R <br />1�1.1-rr1 <br />ADDRESS' 1 <br />�;ll V"' <br />E • Zip <br />c4R�QiF Phi 1 <br />����t�7\\'�l.• <br />PHONE �G�77 " '�J"l C) <br />//l�:-.Q <br />PROPOSED USE OF BUILDING <br />Building <br />MechaniCal <br />Addition <br />HEAT SOURCE <br />PERMIT <br />I.R.( Combination <br />Plumbing <br />WORK <br />Alteration <br />R Electrk <br />TYPE <br />�..j Demolition <br />Sign <br />TYPE <br />New <br />L,j Gas <br />'-Sprinkler <br />Repair/Mi <br />u Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />MJ �CII X.l. ����, <br />���,tLX� ��� <br />��A ik <br />�+ <br />�. PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK(SERVICE.!BAR/MOP/ETC.) <br />OTHER <br />_ <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <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 ON 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 />9ACTORS LAW 18.27 RCW AND 296.200 WAC. <br />