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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 />6--�D g -. <br />In. oo393 e000 o o Sao <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />DoS = p <br />LEGAq <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />I wY s�03 I rrtt -yo; <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />© % t2-el[��� 5AAL-J,-J 2 72.7. 11Z2 <br />CONTRACTOR`J - ADDRESS ZIP CONTR. LICENSE # <br />' � nos 4TO AV4 S <br />- <br />PHONE Zo6W A I ZZ C,! -s)4 cj IS34 <br />PROPOSED USE OF BUILDING <br />Building echanlCal <br />Addition <br />HEAT SOURCE <br />PERMIT <br />Combination Plumbing <br />WORK AlleraC:.: <br />D Eladdc <br />TYPE <br />Demolition Ign <br />k <br />TYPE <br />B Gas <br />Sprinkler <br />10;(91a air/MaInL <br />Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION '--j" <br />/� St�a� CASN�1J <br />12EpL cT IAJ ��rt-r�`� zrr tp\(S74-� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO.. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILL-M <br />A!C—A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />_ <br />KITCHEN SINK & DISPOSAL <br />CLOTHES DRYER <br />DISHWASHER <br />RANGE HOOD <br />_ <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 />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />OTHER <br />OTHER <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 OK CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I Al A AUTHORIZED BY THE <br />OWNER OF THIS PROPE TY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WIT, 1 THE STATE <br />CONTRACTORS AND 296.200 WAC. <br />5 rz S (o <br />Signature of C ntract /A D zad Agent Dale ` <br />/, <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />