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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 1 PARCEL TAX I.D. # PE iff # <br />LEGAL LOT NO. BLOCKf TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />f3OcIyG <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />(�nl /d G — <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />PHONE /-rI,1-ow/ CDA/C?Y% UCrt01/ <br />PROPOSED USE OF BUILDING <br />n Building D Mechan <br />Addition <br />R <br />HEAT SOURCE <br />Electric <br />PERMIT Combination U Plumbingical <br />WORK <br />Alteration <br />(LFH'-J}( <br />TYPE Demolition U Sign <br />TYPE <br />B New <br />Gas <br />Sprinkler <br />Repair/Maim. <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />CONTRACT PRICE OF WORK ` OOO <br />WORK DESCRIPTION <br />lNS 1-4-L L, PA-LL(sT ILk", <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ WATER CLOSET (TOILET) <br />_ BATHTUB <br />_ LAVATORY (WASH BASIN) <br />_ SHOWER <br />_ KITCHEN SINK & 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 />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — AJHANDLING 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 />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRJE 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 APPLICATI N IS MADE AND I COMPLY W ITH THE STATE <br />CON I LA S CW D 288.200 WAC. - y ' <br />Al// O OS <br />Signature of OWneDGonaactorfAumunzeu ryu n -- - L <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />