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� �. <br /> PERMIT APPLICATION . ' I <br /> CITY OF EVERETT PERMIT SERVICES f�03��"� <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 �.��'� <br /> 425-257-8870-FAX 425-257-8857 <br /> I ��„� �oc o,� <br /> SRE ADDRESS PARCEL TAX I.D.� IT t <br /> i 5C�2 �i7��C�.r�K WQ`; Q0��2OO�a I"100 ' 7�,5- (J� <br /> �EGAL LOT�–p7. BLOCK TRACT 1 ' c <br /> I DESC � I PJ�V�'}�j-7 'H��w7 bI� � <br /> � OYVNER ADDRESS ZIP PHONE <br /> cxrr�-x w� G�i� �v�t�e�t- vV�r � we� `�azo3 <br /> TENAMT NAAAE CONTACT FOR PERMIT PHONE <br /> i E7Cp'�� WP�• I I,EVIrI NI�Al.L{STP� `�2,5''�8 45T� <br /> COMTMCTOR ADDRESS LP CONTR.LICENSE� <br /> f"t)F�T NfE�T Cort-�f�t+CCI�N. !'.o.e�XJX 3� qp, <br /> , PHONE �1_1(�{�rU/� WL�C LG'ZZ�j <br /> � '-lt� ' 2 0 � <br /> � PROPOSEQ USE OF BUILOING I BUildiOg Mechaniwl Addillon HEAT SOURCE <br /> �(�,.–�. �j�� PERMIT � Combination � Plumbing WORK �terelion n ElecUic <br /> TYPE Demolitlon Sig� T"PE New .�l Gas <br /> Spnnkl8r Repair/Maint, LJ Other <br /> CONTRACT PRICE OF WORK 'JJ�� �� ���` CITY OF EVERETT LOCAL SALES TAX CODE IS J106 <br /> WORKDESCRIPTION CcNsiec,�GT�oN c?' a- Gr-,u �Ult�r.�(nl6 WCf{+ a <br /> M��tal. eocP s�srq-t �.r�n sror-��or1T 611�x. <br /> � �5�� �'�1'7,=j� <br /> i PLUMBING ME4HANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> I WATER CLOSET AIC–AIHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> j � LAVATORY(WASH BASIN) HEAT PUMP <br /> I _ HOWER UNIT HEATERS <br /> I _ K HEN SINn 8 OISPOSAL _ OTHES DRY <br /> I = DIS ASHER _ RA E HO <br /> L1UND TRAY WAT TER <br /> I _ CLOTHES ASHE _ MET EPLACE/STOVE <br /> URINAL FI LAC_ SERT <br /> DRINKING FO AIN S FIRE�LA <br /> FLOOR D GAS RANGE <br /> BACKFLO PREVE ER GAS PIPING <br /> SINK(S VICE/BAR/ .OPlETC) EXHAUST FAN <br /> _ OTH�R OTHER <br /> I — <br /> iI NEREBY CERITIFY THAT I HAVE READ AND EXAIdINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISI�NS OF 1AY15 AND ORIDINACES GOVERNING THIS TYPE OF VJORK IMLL OE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> INOT THE GRP.NTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE Oi±LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED 6Y THE <br /> � OYR7ER GF THIS PiiOPERiY TO PERFORId THE VJORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT �1QR5 LqiV/7B 27 RC D 98200 WAC. <br /> `—�'�i-,4�') � /���Q,{'� �5-2� o� <br /> S�a o er ontract rf u onzed Agent ate <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> ��� <br />