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� ERMIT APPLICAT�JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> �j � 425-257-8810— FAX 425-257-8857 <br /> ��)--�L�� �1 � i=��� <br /> SI7E ADORESS PAHCEL TAX I.D.S I PERMIT x <br /> / �o ,�t i9 309 "'C�0 <br /> LEGA LOT NO. BLOCK TRACT ,�/ <br /> DESC. , — d'�} � � <br /> OWNER ADDRESS LP PHONE <br /> �A fZR�1 I�3Z►'� ,J /g� .&K�:� �6�1a-Y ,c%�c�T <br /> W�- ����' <br /> TENANT NA E I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR /1� � � �✓e�j� ADDRESS ZIP CONTR.LICENSE M <br /> 7) �11 <br /> PHONE �`�v � ���� �/ <br /> PROPOSED USE OF BUILDING pERMIT I-t Spr nkleation u Sign b n9al TYPE Rapa�ir/Meinl, HEAT SGeRric <br /> TYPE H Demolition U U Other <br /> LJ <br /> CONTRACT PRICE OP WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> ��c��ss ►o.� syS�c•u r�� t�v� • <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FlXTURE OR REM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ IAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> D�SHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPIACE/STOVE <br /> URINAL FIREPLACEINSERT , <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING / <br /> = SINK(SERVICE/BAR/MOPlETC.) = EXHAUST FAN �� � <br /> OTHER OTHER <br /> — � <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND OflIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfFiER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIiY TO VIOIATE OR CANCEL THE PR�VISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br /> OWNER OF THJIS PROPERiY TO PERFORM E WORK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONTR�0 S LAW�CW AND 296. 0 WAC. <br /> ,G(/(j-- <br /> Signature ot OwneriConiractorlAulh ized Agent Dato � <br /> � L <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />