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PERMIT APP:LIC„ATION <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 />PARCEL TAX I.D. # PERMIT # <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />O'C<60 <br />0- <br />TENANT NAME CONTACT'FOR PERMIT PHONE <br />` <br />C014TRACTQR ADDRESS ZIP CONTR. LICENSE # <br />PHONE l <br />PROPOSED USE OF BUILDING <br />Building-, <br />Combinationpechb�jnlcal <br />amng <br />TYPE Demolition gn <br />WORK <br />TYPE <br />AdditionPERMIT <br />Alteration <br />w <br />Electric <br />Sprinkler,.... <br />Repair/Ma int. <br />S' <br />Other <br />CONTRACT PRICE OF WORK /�}212 <br />/ C/ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS3105 -. <br />WORK DESCRIPTION <br />p <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO.. TYPE OF FIXTURE OR ITEM <br />91 <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 />BACKRLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />i <br />_L <br />r <br />I <br />fV�-A/HANDLING UNITSIv <br />FORCED AIR SYSTEMS QQ <br />HEAT PUMP �0 <br />UNIT HEATERS V1 <br />CLOTHES DRYER V6 <br />R^"' , - t oZca <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT ,i• <br />GAS FIREPLACE V <br />GAS RANGE <br />GAS PIPING X <br />EXHAUST FAN B U <br />OTHER <br />5�1_ <br />3 <br />I <br />i <br />I_ <br />,r <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 LAIN REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION: THAT I AM 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 18.27 RCW AND 296.200 WAC. <br />`J1�a�oS <br />Signatu of Owner/Contra o uthorized Agent Date <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />