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7- s <br />PERMIT APPLICATIOt4 <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />J <br />h rL <br />SITE ADDRESS PARCEL TAX I.D. # P RMI a �y I <br />r., R t "/ `- (r '1 v, n t; I ri .i 2 . 3 iS J <br />i f/ <br />LEGA LOT NO. BLOCK TRACT <br />nFSC. �2 <br />i: A N r J st J A M S C <br />( 4 t ) <br />513-vlS; <br />TENANT NAME CONTACT FOR PERMIT PHONE: <br />St 1,7 SoIJ 'S 399 <br />R g-A 7 _r1CI= r� li / 3 / <br />CONTRACTOR ADDRESS ZII <br />PHONE t r` l <br />CONTR. LICENSE M <br />PROPOSED USE OF BUILDING <br />PERMIT <br />TYPE <br />RBuilding <br />Combination <br />Demolition <br />Sprinkler <br />Ll <br />Mechanical <br />Plumbing <br />Sign <br />WORK <br />TYPE <br />Addihon <br />Alteration <br />New <br />Repair/Maint. <br />HEAT SOURCE <br />lectric <br />Was <br />LLLJJJ Other <br />CONTRACT PRICE OF WORK <br />/,r C%� — <br />G <br />CITY OF EVERETT LOCAL SALES TAX <br />CODE IS 3105 <br />WORK DESCRIPTION <br />cI!!n <br />Ry` lk0 1 Tl 00 <br />� <br />S, F <br />� <br />r•t r4 A 1F�1 .�� <br />L Cr., vFtiS � �ti1 <br />T -, � <br />Gam• <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />t <br />WATER CLOSET (TOILET) <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 />_ <br />_ <br />= <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 FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER__ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <br />_ <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 GRANTI'. i 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 18.27 RCW AND 298.200 WAC. <br />_ -7 <br />Signature of UwnerlContrect t uthorized Agent Date IZ <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />