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�tRMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-8810- FAX 425-257-8857 <br /> 03 io -003 <br /> SITE ADDRESS PARCEL TAX I.D.# I PERMIT p <br /> 1�r�4 - l3h��a-� o _e�r <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE I <br /> � / <br /> Jf1M✓� 4 I�P�•� ��i�Y' �O��a� qflzoJ •/z�- cs7 9� 3y <br /> TENANT NAME I CONTACT FOR PERMIT P�IONE <br /> � <br /> J�w..,. � i�v�...i J/�mw i' ad.m--- S�Zr- �vY-i��i <br /> CONTRACTOR AD�RESS ZIP CONTR.LICENSE M <br /> PHONE N/1 <br /> PROPOSED USE OF BUILDING I Building D Mechanical AdCilion HEAT SOURCE <br /> PERMIT B Comb(nation U Plumbing WORK B Alleratlon I (� Eleclnc <br /> �Jks���r�d` 7YPE D Demolition U Sign TYPE D New D Gas <br /> Li Sprinkler U Repalr/Malnt. �J Other <br /> CONTRACT PRICE OF WORK ��� CITY OF EVERETT LOCAL 9ALE3 TAX CODE 19]103 <br /> WORK DESCRIPTION . <br /> .�NSTna� �T r Co�P Liw.L� �✓^ lw+N.��G <br /> �� Dk4,r �..;.< i� „ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> __ WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> _ BATHTUB FORCF.D AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER� <br /> DISHWASHER rZ4NGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES'NASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS fIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK (SERVICE/BAR/MOP/ETC.) = EXHAUST FAN <br /> OTHER _ OTHER <br /> I I <br /> I HEREBY CERITIFV THAT I HAVE READ AND EXAMINED THIS APPI.ICATION AND KNOW THE SAME l'O BE TRUE AND CORRECT. ALL <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING TMIS TYPE OF WORK WILL BE COMPLIED WIT'H WHE?HER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A P[RMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF AN1'OTNER <br /> . STATE OR LOCAL LAW REGUL4TING CONSTRUC710N OR 7HE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> iOWNER OF T IS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRA R LAW 18.27 RC D 296.200 WAC. <br /> � � <br /> hti^ S� � /O -(o- UJ <br /> t� e of Owner/ContractorlAuthonzed Agent Date <br /> � DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> L-- _— _---'— — J <br />