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� �ERMIT APPLICATI N <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.# PE IT n <br /> L A � 00 � <br /> LEGA LpT NO�. BLOCN TRACT <br /> DESC. A /t7/1POAl OF O F O� �S !�1 <br /> OWNER ADDRESS 21P PHONE <br /> f�ioh,'n t ��LE�'n/ t7�RI1�' y2s 2G7 - 97e 9 - <br /> TENANTNAME' I CONTACTFORPERMIT PHONE <br /> .Tprn� A-s A�d� l�oh�✓� ,I�RN� 98 3 _ <br /> CONTRACTOR A�DRESS 21P CONTR.IICENSE p <br /> PHONE <br /> PROPOSED USE OF BUILDING 'TI�""�Building R MBChanical R Addilion HEAfT�SOIIRCE <br /> I TYPE'T F-( SPrinklleon�n u Sign bin9 n.PE I--( RePalr/Malnt. v OtheNc <br /> A LT � �� �� - <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA7(CODE IS]105 <br /> WORKDESCRIPTION ��5i��(>- ��}�J� N�BfJ•S �ti/5'P�G'�/DA� �D/L <br /> �DG(LT rA�'IiLrJ. L�A2t� ,�M6 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXNRE OR ITEM <br /> WATER CLOSET(TOILET) A/C–AIHANDLING UNITS <br /> BATHTU� FORCED AIR SYf�TEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> I DRINKING FOUNTAIN GAS FIREPLACE <br /> � _ FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) GXH�UST FAN <br /> OTHER OTHER <br /> � — — — <br /> i <br /> i <br /> � i HEREBY CERITIFV THAT I HAVE READ AND EXAMINED-HIS APPLICATION ANU KNOW THE SAME TO BE TRUE AND GORRECT. ALL <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING lt dS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> . NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIULATE OR CANCEL THE PROVlSION OF ANY O7HER <br /> '� STATE OR LOCAL LAW REGULATING CONSTRUCTION OR?HE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> , OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br /> I CONTRACTORS LAW 18.27 RC' AND 296.200 WAC. <br /> � ��i�'/es <br /> Sign ure of OwnenCo r rodA�u ofnzed Agent D�ate <br /> � DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />