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tntoc�v�� <br /> — - � - <br /> PE�MIT APRLICATIOIv <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS �2 PARC�TAX I.D.# PERMIT# <br /> �}l� � n 1 /J�/'>� . '� � <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> —'�, - �n� nA� n ^^� ! D�E��.S�� ,�,y� /7�,/Jf� l i n ZIP PHONE <br /> V CJ1\.!l/vlX.a( �L:'I i�l J�1f.J�7C,S V1A)V�w�� <br /> C�1PJ�i�P, �).)Fl �1 U201 I��4?�,' 3I�- ' o�5 I <br /> � �����,,� AC,,ONTACT FnO1R�P"Ef�tM1T `� PHONE <br /> �Q.'��.► �n� �f �l. u �61�.Q� VIVU�x.1.011 � f0�'C7 f�l _ <br /> C�N,q�7pR,�� I��I „QDDR�SS,^- ', _ ZIP CONTR.LICENSE p <br /> \ IV1f1/\) CXO..iL Y 111 ! � �..l� <br /> Y '\WfN r�iU r.i tM/ ` R+ti�t�(�.� c�,1�C <br /> �PHONE I� �� �UO ! � I/�I /�Q/]✓..1y2 <br /> „� ,�•V l� "( OOYJ:� _ <br /> pR Building Mechanical Additior HEAT SOURCE <br /> `���YR�S�\.JS./1W V�.a�C/ PERMI7 R Combination �Plumbing WORK � Alteration �Electric <br /> TYPE Demolition U Sign TYPE New Gas <br /> Sprinkler Repair/MainL Other <br /> CONTRACT PRICE OF WORK � 1'�1 I 1 O�� h/1 GTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> d`I � �v <br /> WORK DESCRIPTION ��^y �Q� [�. 1 �-�-y n <br /> ��� , v) 1!.���lh� ��1 ��, uA�.JliI�CL��'�,�� \"t((,�/1 V 1' / <br /> � ` .. '� � �) <br /> � 2 <br /> PLUMBI G MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOIL[T) AiC–NHANDLING UNITS <br /> BATHTUB Z FORCED AIR SYSTEMS <br /> LAVATORY^NASH BASIN) HEAT PUMP <br /> SHOWER � _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> DISHWASHER ' RANGE HOOD <br /> LAUNDRYTRAY � WATER HEATER <br /> CLCTHES WASH[R � METAL FIREPLACE(STOVE <br /> URINAL �� FIREPLACEIYSERT <br /> DRINKING FOUNtAIN GAS FIREPLACE <br /> FLOOR DRqIN GAS RANGE <br /> BACKFLQW PREVENTER � GAS PIPING <br /> SINK SERVICE/BAR/MOP/ETC.) �j_ EXHAUSTFAN <br /> OT �R OTHER <br /> �' — — <br /> I I HEREBY CERITIFY'fH:�T I HAVE READ AND EXP.MINED THIS APPIICATION AND KNOW THE SAME TO BE TRUE AIvD CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF VJORK 1'JILL BE COMPLIED WITH WHETHER SPECIfIED HEREIN OR <br /> �JOT. THE G JTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIiY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHlER <br /> STATE OCAL V F.EGULATING CONSTRUCTION OR THE PERFORMANCE OP CONSTRUCTION. THAT I AM AUTHORIZED DY THE <br /> ' GV2NE OF THIS PRO RTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY 1'JITH THE STATE <br /> i C NT � CTORS LAW'I 27 RCW AND 296.200 WAC. <br /> ---- c�.�v �ao� <br /> Sig a ure f OwneriContrectodAuthorized Agent Date �/Z <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />