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� <br />��NERMIT APPLICATION <br />CIiYO M S <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 -FAX 425-257-8857 <br />SITE ADDRESS <br />PA.ZCEL TAX I.D. # <br />PERMIT x <br />(1%CI I �1 (�V Peen <br />Ccv3a�-(-o3� <br />L <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />lF` <br />OWNER ADDRESS ZIP PHONE <br />N <br />'�,C�,ItitbrIc� Heir;/n-e-2 <br />_ <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />KQ�In !�(o�.�ta � J� IsM <br />►oc,:l L�m4gLte,rE�h1LIZ3- La.lri� <br />CONTRAC 0 ADDRESS � ZIP CONTR. LICENSE # <br />PHONE <br />� <br />PROPOSED USE �OF BUILDING <br />i�l � ��w.� <br />PERMIT <br />Building Mechanical <br />�{I [;� <br />R Combination � Pl�mbing <br />dition <br />WORK RAtteralJon <br />HEAT SOURCE <br />Electric <br />U�-��-'1"✓�� <br />TYPE <br />B Demolition Sign <br />TYPE New <br />Gas <br />Sprinkler <br />RepairlMaint. <br />06ter <br />CONTRACT PRICE OF WORK <br />V <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />WORK DESCRIPTION � <br />vx� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A/C - A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK F. DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <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 <br />RANGE <br />_ <br />BACKFLOW PREVENTER <br />_GAS <br />PIPING <br />_ <br />SINK (SERVICE/BARfMOP/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER <br />OTHER <br />I 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 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 />Signature off Oar/Contri for/Authorized Agent ate <br />L <br />�' DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />'PERMIT APPLICATION <br />