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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 />SITE ADDRESS PARCEL TAX I.D. 0 PERMIT N <br />--n q)v s-I. Sc _. d', oS�A von a3g op rvt oJi�-ooz <br />LEGAL LOT NO. BLOCK I TR4CT <br />DESC <br />OWNER ADDRESS ZIP PHONE <br />-S;.YY`es Cop i, So c ziijD S� 5�- ylm)b ygs --513 (VI5 3 <br />TENANT NAME CONTACT NAME PHONE <br />CONTRACTOR <br />ADDRESS <br />ZIP CONTR. LICENSE 0 <br />00�) V� Q� <br />PHONE <br />PROPOSED USE OF BUILDING <br />Building <br />Mechanicnl <br />Addition <br />HEAT SOURCE <br />PERMIT <br />Combination <br />Plum)niy <br />WORN <br />AlterationQ <br />Electric <br />TYPE <br />IR-( <br />�..J Demolition <br />Sign <br />New <br />6 Gas <br />U Sprinkler <br />(TYPE <br />RepavrMairl. <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVE RETT <br />LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION rw.i+[r 1� rnr, ( CS If1-i"0 ire pjCjcZ. <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 8 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 />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />/ <br />_ <br />J <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 FIREPU- CE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />1 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 OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS PROPERTY TO PERFOR A THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18 27 RCW AND 296,200 WAC. <br />