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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 DRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />% 7— ��*• <br />OIJr 4//3aoro/Soo <br />�3/a -Oz 7 <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />OWNER ADDRESS 21P PHONE <br />'-f*C Q-/etc '390!—/�-�o+� o! Vs,2s9-//67 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTRACTOR . I RESS ZIP CONTR. LICENSE # <br />� ct UL�CrT CL/A/rC <br />/L <br />, �L <br />PHONE <br />PROPOSED USE OF BUILDING <br />Building I"1 Mechanical <br />Addition <br />HEAT SOURCE <br />PERMIT <br />R Combination Plumbing <br />WORK <br />R Alteration <br />li Electric <br />TYPE <br />B Demolition Sign <br />TYPE <br />B New <br />B Gas <br />Sprinkler <br />Repair/Mains. <br />Other <br />CONTRACT PRICE OF WORK .4r <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION d � Q <br />/`s"✓�i� a��4.e a d�.� �� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />_ <br />WATER CLOSET (TOILET) <br />A/C — A/HANDLING UNITS <br />BATHTUB <br />_FORCED <br />AIR SYSTEMS <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />_HEAT <br />PUMP <br />_ <br />SHOWER <br />_UNIT <br />HEATERS <br />_ <br />KITCHEN SINK &DISPOSAL <br />_CLOTHES <br />DRYER <br />_ <br />DISHWASHER <br />_RANGE <br />HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />_FIREPLACE <br />INSERT <br />_ <br />DRINKING FOUNTAIN <br />_GAS <br />FIREPLACE <br />_ <br />FLOOR DRAIN <br />_GAS <br />RANGE <br />_ <br />BACKFLOW PREVENTER <br />_GAS <br />PIPING <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />_EXHAUST <br />FAN <br />OTHER <br />OTHER <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 GRANTING OF A PERMIT DOES 1407 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 T E WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CO AC RS LAW 16.27 RC', D 296. WAC. <br />• /0-�3-03 <br />Signature oI OwneuContractor/Authonzed Agent Date I� <br />DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br />