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�ERMIT APPLICATI�UIV <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.# P RMI7# <br /> "Lz(o 2 D�Lc�IAy CJ�o -ol <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 ZIF PHONE <br /> �'���K �� . L�oil/R�P1� Z�� G��'iOGc-.wAy 98�/ y�=z5�_ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADURESS ZIP CONTR.LICENSE X I <br /> PHOHE ��/--�✓ � <br /> V <br /> PROPOSED USE OF BUILDING Buiiding Mechanical I Addition I HEAT SOURCE <br /> � PERMIT B Combination � Plumbing WORK �Alteradon � ElecVic <br /> T'PE Demolilion U Sign IYPE New Gas <br /> Sprinkler RepalriMaint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAl(CODE IS 3105 <br /> WORK DESCRIPTION �u� � �� � �l/12� pG/{.'C, <br /> r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORC.ED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCNEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN � GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> _ BACKFI.OW PREVENTER � GAS PIPING <br /> SINK(SERVICE/BARIMOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> II HEkEBY CERITIFY TNAT I HAVE FEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br /> PROVISIONS O�'AWS AND ORIDINACES GOVERNING THIS.TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM TH WORK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CON7RACTORS LAW 18.27 RCW AIJD 296.20 AC. <br /> � H . <br /> Signa ure of wne onlractor/Authoriz d Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />