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PERMIT FPPLICPTIUN <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 <br />PARCEL TAX I.D. p <br />PERMIT N <br />)L1Lv Both s.,:+<• <br />�D <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />2 Ltm:e L <br />� e rrG� J-J,,r'6 „Cklc �206) 730. 298`i <br />CONTRACTORADDRESS 3500 hJ Py1 V,•Ilfy {{�„�IP CONTR. LICENSE <br />V C1(�'JI �n �MO (� <br />2 <br />PHONE <br />21ou 3`Ic.B <br />e. _ <br />PROPOSED USE OF BUILDING <br />Building f7 Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />Combinal:on Plumbing <br />WORK � Alteration <br />Electric <br />TYPE <br />I <br />Demolition Sign <br />N <br />� <br />TYPE New <br />Gas <br />� <br />Sprinkler <br />Renae/Idainl. <br />Other <br />CONTRACT PRICE OF WORK OOrI oV <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />.m...... See.... -e... <br />WORK DESCRIPTION SL�1eC i'wc �rK� <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET (TOILET) <br />A/C — FVHANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />'_'RINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE)BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER <br />OTHER <br />I HEREBY CERITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRITE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIUINACES 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'.VORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />W <br />CONTRACTORS LAW 18.27 RCWI AND 298.200 WAC. <br />Signature of Owne ontractonAWhorized Agent Date {(L <br />DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br />