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PERMIT APPLICATION <br />CITY OF EVERETT <br />PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />PARCEL <br />PARCEL TAX I.D. #/'� <br />PERMIT # <br />j9 <br />LEGAL LOT NO. <br />BLOCK <br />TRACT <br />DESC. <br />11' "Ts(L Crl Z�Fk4L��N <br />OWNER <br />ADDRESS ZIP PHONE <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />f% <br />Mof - <br />CO TRAC QR <br />n�u <br />ADDRESS ZIP CONTR. LICENSE # <br />�(Z�NsI,� <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />TYPE <br />Er Building <br />CombinationF,eclaniC21 <br />umbing <br />Demolition ign <br />dition <br />;Alteration <br />WORK <br />TYPE w <br />HEATSOURCE <br />Electric <br />�s <br />Sprinkler <br />pair/Maint. <br />���jjjj Other <br />CONTRACT PRICE OF WORK <br />CITY OF`EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />vn <br />MECHANICAL <br />NO. TYPE -OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />D <br />A/C — A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />q <br />LAVATORY (WASH BASIN) <br />---L— <br />D <br />HEAT PUMP <br />p <br />SHOWER <br />UNIT HEATERS <br />I <br />KITCHEN SINK & DISPOSAL <br />- <br />�_ <br />CLOTHES DRYER <br />DISHWASHER <br />�_ <br />.RANGE HOOD <br />� <br />LAUNDRY TRAY <br />j_ <br />WATER HEATER <br />I <br />CLOTHES WASHER <br />® <br />METAL FIREPLACE/STOVE <br />© <br />URINAL <br />® <br />FIREPLACE INSERT <br />ey <br />DRINKING FOUNTAIN <br />_� <br />GAS FIREPLACE <br />Q <br />FLOOR DRAIN <br />GAS RANGE <br />0 <br />BACKFLOW'PREVENTER <br />GAS PIPING <br />0 <br />SINK (SERVICE/BAR/MOP/ETC.) <br />EXHAUST FAN <br />ff _ <br />I <br />I <br />OTHER <br />OTHER <br />j 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 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 APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br />16 f t<s 0 j <br />Signatut of Owner/Contra o uthorized Agent <br />Date <br />I <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />