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� PtRMIT APPLICATIO�N li <br /> I CITY OF EVERETT PERMIT SERVICES �i <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> �� 425-257-8810— FAX�1�5-257-8857 <br /> I <br /> �. SITE ADDRESS PARCEL TAX I.D.# PERM�T# I <br /> . ' � {�dc._...� 5 /�� C.�4� -!�lb <br /> �EGAL � LOTNO. 6LOCK TRACT ��I <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> '�j' � ♦ �cca � " ' �S A�cF�„_S l��,-e �?� 3 �1�� ` �'�'?6 2�— <br /> TENANTNAME CONTACTFORPERMIT PHONE li <br /> I <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE ri <br /> PHONE <br /> ' Buildin Mechanical AtldiEon HEA7 SOURCE <br /> PROPOSED USE OF BUILDING pERMIT I i Sp nk�eation R�..( Plumbing WORK R�( Alteration Q Electric <br /> TYpE H Demolition LJ Sign NPE �j New �j Gas �, <br /> i �J U Repair/Maint. U ONer <br /> ICONTRACT PRICE OF WORK CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> � WORK DESCRIPTION '�, <br /> I I' <br /> ii PLUMBING MECHANICAL I <br /> NO. � TYPE OF FIXTURE OR ITEM NO. TY�E OF PIXTURE OR ITEM ' <br /> II WATER CLOSET(TOILET) _ A/C—A/HANDI.ING UNITS . �! <br /> I _ 'dATHTU6 _ FORCED AIR SYSTEMS I <br /> IAVi,TORY(VVASH BASIN) _ HEAT PUMP I <br /> I� _ SHOWER _ UNITHEATERS � <br /> I _ KITCHEN SINK&DISPOSAL = CLOTHES DRYER <br /> DISHVI'ASHER RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER I <br /> CLOTFiESNlASHER _ METALFIREPLACEfSTOVE �� <br /> �I URINAL _ FIREPLACE INSERT �� <br /> � DRINKING FOUNTAM _ GAS FIREPLACE <br /> '� FLOOR DRAW � _ GAS RANGE <br /> � BACKFLOW PREVENTER _ GAS PIPINCa <br /> ' SINK(SERVICE/BAR/MOP/ETC.) . _ EXHAUST FAN I <br /> -0i'HER _ OTHER I <br /> 1 �� � .�d 1,t��.c — �� <br /> —L— - � �-��� 1� — II <br /> I HE4I B�CERITIFY THAT i HAVE READ AP!D EXAMWED THIS APPLCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL � <br /> PROV�SIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPEGFIED HEREIN OR I <br /> fJOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIQ'.ATE OR CANCEL TH2 PROVISION OF ANV OTHER <br /> � STATE OR LOCAL:AW RF_GULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT� TM A�E SOTATE D BV THE �, <br /> � OVJNER OF?HIS PROPERN TO PERFORM THE'JVORK FOR WHICH APPLICATION IS MADc FND 1 COMPt.V W': <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. , <br /> �I � � �--�.�� 2 2� -a y � <br /> � <br /> �, Signature o-- f GwnedCSntracmnv.u[nonzeo r+genc ��•� <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED ' <br />