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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. q <br />PE T a <br />�rn/o <br />NO. <br />!13L7OCK=LTRACT7�93-000LEGALLOT <br />DESC. <br />��, � � 1 (p <br />OWNER ADDRESS ZIP PHONE <br />13 RA vn7olyp <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />AV 6FA �/ <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE p <br />PHONE <br />PROPOSED USE OF BUILDING <br />Building fl Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />R Combination IIL1�J; Plumbing <br />WORK <br />Alteration <br />Electric <br />I <br />TYPE <br />B Demolition Sigli <br />TYPE <br />Ilew <br />Gas <br />Sprinkler <br />Repair/Maim <br />Olher <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A/C — A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />_ <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE./BAR/MOPiETC.) <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 TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND CRIDINACES 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 P ERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRAC S 18.27 RCW AND 0..00 WAG <br />Si a nerl ,Onl r/ ulhonzotl Agent Date <br />DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br />PERMIT APPLICATION <br />