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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 —FAX 425-257-8857 <br />II r , <br />A <br />SITE ADDRES <br />PARCEL TAX I.D. A <br />PERMIT 0 <br />LEGAL LOT NO. <br />BLOCK <br />,ems <br />TRACT <br />yR'j Mr, � <br />DESC. <br />-fASZGsj5L-a" <br />OWNER ADDRE88LP� PHONE <br />\ l <br />TENANT NAME ^ 1h M �'�TjNrwCv) <br />FOR PERMIT ONE <br />�CONTACT <br />� `P`H'q <br />�l.A`�J�V'�' c�-e�o 2l•'1j 1'SOc> <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE A V/Q�J <br />� '1 <br />PHONE -. <br />PROPOSED USE OF BUILDING <br />(A Building Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />I] Combination Plumbing <br />� <br />WORK <br />I <br />R Alteration <br />D Electric <br />I <br />Wqb�� z� <br />TYPE <br />B Demolition Sign <br />TYPE <br />New <br />UU Gas <br />r�i1K-ate+ <br />Sprinkler <br />Repelr/Helot <br />Other <br />CONTRACT PRICE OF WORK dL �� <br />CITV OF EVERETT LOCAL SALES TAX CODE 19 2105 <br />WORK DESCRIPTION 2�4 — a- • �AwX -�-tt T� t� L•6�E <br />4i� �Ip'r+r�wl-� SITE It.nfYzc„/'c-�IE1 t"r•5• <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM PER.NIcT— <br />N0. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET <br />AIC- AIHANDLINGUNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />_HEAT <br />PUMP <br />_ <br />SHOWER <br />_UNIT <br />HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />_CLOTHES <br />DRYER <br />_ <br />DISHWASHER <br />_RANGE <br />HOOD <br />_ <br />LAUNDRY TRAY <br />_WATER <br />HEATER <br />_ <br />CLOTHES WASHER <br />_METAL <br />FIREPLACE/STOVE <br />_ <br />URINAL <br />_FIREPLACE <br />INSERT <br />_ <br />DRINKING FOUNTAIN <br />_GAS <br />FIREPLACE <br />_ <br />FLOOR DRAIN <br />_GAS <br />RANGE <br />_ <br />BACKFLOW PREVENTER <br />_GAS <br />PIPING <br />_ <br />_ <br />SINK (SERVICEIBARIMOPIETC.) <br />_EXHAUST <br />FAN <br />OTHER <br />OTHER <br />I HEREBY CERITIFV 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 />OF HIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS W 18.2T'R61eLBND 288.280 WAC. <br />i o edContra or ut orize gent ate <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED �7� <br />