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PERMIT APPLICATION <br />CITY OF EVERUT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br />SITE ADDRESS <br />PARCEL TAX I.D. N <br />PERMIT a <br />5' .z r ,, `` ', r �, "'. <br />M Ol G -D Z <br />LEGAL <br />L0 N0. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER <br />ADDRESS <br />PHONE <br />u l/l 1, <br />',7 7. / 7y �$ts•F. <br />.317 '7 i <br />tn, y <br />TENANT NAME <br />I CONTACT NAME <br />PHONE <br />CONTRACTOR <br />ADDRESS <br />CONTR. LICENSE R <br />;Are t 'Ile rn' <br />l u //,, /YJo�inr ✓/Itu U' <br />Fv �-/,r 5 ,: )c <br />PHONE y,75'15J'4r�v <br />cut,r)`� 4.4 IiraG/ <br />PROPOSED USE OF BUILDING <br />Building _Mechanical <br />addition <br />HEAT SOURCE <br />PERMIT <br />Combination Plumbing <br />WORK <br />Alteration <br />Electric <br />TYPE <br />Demolition D Sign <br />TYPE <br />New <br />Gas <br />Sprinkler <br />UUU Repair/Maint. <br />Other <br />CONTRACT PRICE OF WORK i47 -q r1 • <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION , �wi'u . , /fa/ 4� dt t -r-l'- <br />PLUMBING <br />MECHANIC <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET <br />A/C - A/HANDLING UNITS <br />_ <br />BATHTUB <br />I <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />KITCHEN SINK 8 DISPOSAL <br />CLO FHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAi <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />_ <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 />_ <br />BACKFLOW PREVENT.ER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER <br />I HEREBY CERTIFY 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 />OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 16.27 RCW AND 296.200 WAC. <br />9 <br />y <br />- � y <br />Signature of Owner/Contractor/Aut onzed Agent <br />Date <br />