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� <br /> �ERMIT APPLICATIUN '' <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.M PERMi7 a <br /> 5�z C''•¢n �� KC�3oq-ppZ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �4L(� ,�O�CI✓OVG/4� <br /> TENANT NAME I CONTACT FCR PERMIT PHONE <br /> CONTRACTOR ���NSvN �9L��, ADDRESS ZIP CONTR.LICENSE N <br /> PHONE �'�o��3 . 7�� �-933� /2�� �� ti-� 98'22J ,�Og i.�.A�?7 <br /> PROPOSEU USE OF BUILOINO R Bullding � MBChaniCal R Addition HEAT SOURCE <br /> PERMIT K Spd kileaflon Flumbin;� WORK I� Rlepair�Malnt I IJ Othec I <br /> SrJ�—� TYPE RQ Demalilion Sign TYPE au Naw Gas � <br /> CONTRACT PRICE OF WORK .�3 S-�c�U CIT1 OF EVERETT LOCAL SALES TAX COOE 19 3105 <br /> WORK DESCRIPTION • <br /> /NS7r4u_ IblIJ-E S�i�/..-/CCG� / N Sf� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER � UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASNER METAL FIREPLACE/STOVE <br /> URINAL FIRcPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING � <br /> S�NK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> — — `I' .P+�.KC[�.S <br /> I H=REBV CERITIFV THAT I HAVE READ AND EW+MINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PF'OVISIONS OF LAWS AND ORIDINACES GOVERNING iHIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NCT. THE GRANTiNG OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO`JIOLATE OR CANCEL TME PROVISION OF ANY OTHER <br /> e.'ATE OR LOCAL LAW REGULATIN(i CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF 7HIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS 6.'ADE AND I COMPLV WITFI THE STATE � <br /> CONTRA�LAW�27 RCW�JO 296.200 WAC. �/O 2 ' <br /> � � , <br /> �i 9 � <br /> Signature of Owner/Con nAuthonzed Agent -'—bate � � I <br />- -_ DEBIT& CREDIT CARDS ARE NOT ACCEPTED___ I <br /> i <br />