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PERMIT APPLICATIUN <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.• rE iT a <br /> .,2�OS �-��-�— 3 v - <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �3�/.� EX�� �' �J�. �as �J.�,....� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR i / �/P /' ��,� 7-N� ADDRESS 7r��6 f7� �+- 'I- 21P CONTR.UCENSEN <br /> ��a <br /> PHONE S'�,.� �a� �z SSOZG t-l�� lM� <br /> � 9�toS� <br /> PROPOSED USE OF BUILDING I TMPEIT B Spnnklle�n n � S 9n b n9 I I�E V Repairf/Maint. I HEAT SG h�E <br /> n <br /> J <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> WORK DESCRIPTION <br /> N�- �z�2, c,�o.�- �- � i3�.�r,`�.�._ f 1 ���.��.— <br /> r ���J `�c-`1�'- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> a WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> .Z LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> 1 KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> i DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> � FLOOR�RAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <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 COMPIIED WITH INHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRC-SUME TO GIVE AUTHORIN TO VIOUITE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE nR LOCAL LA�V REGULATING CONSTRUC710N 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 1 CDMPLY WITH THE STATE <br /> CON7RAC70RS IAW 18.2 CW AND 296200 WAC. <br /> �f� � 5'/ay/3 <br /> Signature of nedContractodAu� nzed Agent Uate �' <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEP�EJ ��� <br />