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P RMIT APPLICATIC�N <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.# PERMiT# � <br /> �330� s�=��TC. cc,�-_L Uo�� S� �s �oz r�o �coyolo-ac1�! ' <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> ,�, �L /`� 35 /�-� 33 � .Z s. � 7<< � � �.��; yzszszz�- <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � <br /> c� � c �v-�� <br /> CONTRACTOR �££ S ��wvl��j�, ADDRESS ZIP CONTR.LICENSE# <br /> � <br /> PHONE .?,�� G - �/q !- l3� q <br /> / ✓ � J / <br /> PROPOSE�USE OF BUILDING I� Building Mechanical Addition HEAT SOURCE <br /> PERMIT K Com6ination � Plumbing WORK � Alleration � Electric <br /> 7YPE �..j Demolition Sign 1YPE New Gas <br /> U Sprinkler RPpairlMaint. Other <br /> CONTRACT PRICE OF WORK CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A!C-A/HANDLWG UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> —T LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SIIOWER _ UNITHEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACElSTOVE <br /> � URINAL _ FIREPLACE INSERT I <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOCR DRAIN _ GAS RANGE I <br /> BACKFLOW PREVENTER GAS PIPING i <br /> SINK(SERVICEIBAR/�10PIETC.) ✓ EXHAUST FAN <br /> OTHER _ OTHER <br /> i — <br /> � � <br /> I I HEREBY CERITIFV THAT I HAVE REAO AND EXAIdINED THIS APPLICATION AND KNOW THE SA�1E TO BE TRUE AND CORRECT. ALL i <br /> PROVISIONS OF WWS AND ORIDINACES GOVERNING THIS T1'PE OF N'ORK WILL 8E COMPLIED WITH WHETHER SPEqFIED HEREIN OR �i <br /> NOT. THE GRANTING OF A PERM1IIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER �, <br /> � STATE OR LOCAL LA'.N REGULATING CONSTRUCTION OR TFE PERFORAIANCE OF CONSTRUCTION. THAT I AA1 AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR 1"JHICH APPLICATIOV IS MADE AND I COMPLY LVITH THE STATE ,, <br /> CONTRACTO 5 L�VN 1027 RCW AND 296200 WAC. <br /> ���� l� >.-�— ����� <br /> I ignawre of OwnerlContracrorlAuthonzed Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED � <br /> i <br />