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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 PARCEL TAX I.D. # RMI tt <br />LEGAL LOT NO. BLOCK I 7R/ CT <br />DESC. <br />OWNER hr)DRESS ZIP PHONE <br />/� <br />�vtz; � C� JC% � /�-7 P-UL-JcEL <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />CONTFACTOR ADDRESS ZIP CONTR. LICENSE N <br />G-- <br />PHONE <br />PROPOSED USE OF BUILDING <br />Q Building Mechanical <br />PERMIT I) Combination� Plumbing <br />(WORK 3C) <br />Addition <br />Alteratlon <br />I HEAT SOURCE <br />Electric <br />iC <br />TYPE Demolition U Sign <br />TYPE <br />B New <br />Gas <br />� <br />B Sprinkler <br />Repair/Mainl. <br />Other <br />CONTRACT PRICE OF WORK 417 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />N0. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />A/C - A/HANDLING UNITS <br />_ <br />BATHTUB <br />_FORCED <br />AIR SYSTEMS <br />_ <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />HEATERS <br />_ <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />_UNIT <br />_CLOTHES <br />DRYER <br />_ <br />_ <br />DISHWASHER <br />RANGE HOOD <br />WATER HEATER <br />_ <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />_ <br />FLOOR DRAIN <br />_GAS <br />RANGE <br />GAS PIPING <br />_ <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />_ <br />OTHER <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE RE..D AND EXAMINED THIS APPLICATION ANC KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE <br />GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO <br />REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />STATE OR LOCAL LAW <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,RC AND 296.2� O�WAC. <br />Signature of Owner/ContractorlAuth nzed Agent Date <br />DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />