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�ERMIT APPLICATIJN � <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.M PERMiT• <br /> ' v e I M�3 o y-ors <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP P NE <br /> %`a�°7�S-v9 i a <br /> �'- 9 �+:����nn w e�-Do0 9803 ( <br /> TENANT NAME CONTACT FOR PERMIT PHONE '' <br /> CONTRACTOR _ , �J_ /�,/ � , , ADDHESS ZIP CONTq.LICENSE N <br /> fiL(/�'�-C�iC(.(�� <br /> �7 J <br /> PNONE /1��'� / .i.7 — Y I /ti <br /> 7 <br /> PROPOSED USE OF BUILDING � Building Mechenlcal Additlon HEAT SOURCE <br /> PERMIT Combinatlon � Plumbing WORK R Alteretlon � Eloctric <br /> TYPE Demolilion Sign TVPE D NaW aa: <br /> Sprinkler U HepaldMe�nt Olher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORN DESCRIPTION <br /> /�euJ ��G S ��.u�nGz-� � �d��.�-�'�21��Riwl� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF Fl%TURE OR REM NO. TYPE OF FlXTURE OR REM <br /> _ WATER CLOSET A/C-A/FiANDI.ING UNITS <br /> _ BATHTUB T FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BAS�N) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATEFS <br /> _ KITCI�EN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANOE HOOD <br /> _ LAUNDRY TRAY � N/ATER HEATER <br /> _ CLO7HES WASHEH _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> __ DRINKING FOUN7AIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PRE`JENTER � GAS PIPING <br /> _ SINK(SERVICE/BAR/MOPrETC.I _ EXHAUST FAN <br /> _ OTHER __ _ OTHER <br /> I FiEREBV CERITIFY THAT I HAVE READ AND E%AMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF U1W5 ANO ORIDINACES GOVERNINO THIS TYPE OF WORK WILL BE COMPLIED WITFI WHEfHER SPECIFIED HEPEIN OR <br /> NOT. THE(iRANTIN6 OF A PERMIT DOES NOT PFESUME TO GIVE AUTHOFITV TO VIOLATE OR CANCEL THE PROV�SION OP ANY OTHER <br /> STATE OR LOCAL LAW REGUUITING CONSTRU:T�ON OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORI2ED BV THE <br /> OWNER OF i�li1S PfiOPERTV TO PERFORM THE WORK FOR JJHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 298.200 WAC. <br /> ����-C�iZ /`�t��z� h�/� D � <br /> � �gnature o wned on ractoUAuthon ed Agent �te <br /> � DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> I <br />