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� 'r-ERMIT APPLICAT�JN <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.N PERMIT a <br /> ?_OI`t f3roac� �ay f1� e • ooy3 � 9yzooZsa� $�3Q�}-OG <br />' LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER . ADDRESS gZ1201 PHONE <br /> '�eanV, 't��ltManh zoiV QroaJ way AvQ. � Evar¢it�WA NzS-3� 7-•933z <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> /� <br /> �da�n 3o0J��h � `Sezn V ���ritnh <br /> CONTRACTOR ADDHESS ZIP CONTR.LICENSE N <br /> PHONE <br /> PROPOSED USE OF BUILDING I7 Building Mechenical Addition HEAT SOURCE <br /> PERMIT � � Combination � Plumbing WORK B Alteretion (� Electric <br /> TYPE �..( Demolition .�� Sign 7YPE ❑ New � Gas <br /> LJ Sprinkler U RepaidMaint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> ��j INSiALL i �tUrv� iuA1ED SION � F2or.iT - 5treet - n�dC <br /> ;� POST 1.�• SIUN aN a� ���,Nc� �. Rr•_n2 - ane � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR REM NO. TYPE OF Fl%TURE OR ITEM <br /> WATER CLOSET _ A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN 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 /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I _ I — <br /> I I HEREBY CERITIFY THAT I HAVE READ hV0 EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � PROVISIONS OF LAWS AND CRIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OP <br /> NOT. THE GFiANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOFiITY TO VIOL4TE OR CANCEL THE PROV�SION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TH�4T I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTfiACTORS lAW 18.27 RCW AND 236.200 WAC. <br /> '—� �-�• (��--5 y�i��°3 <br /> Signamre ot OwnerlContractodAuthonzed Agent Date I/ <br /> i <br /> � DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />