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P�tRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SI�ADDRESS PARCEL TAX I.D.A PF.RMiT a <br /> � �109 � rno3�c, -o�� <br /> LEGAL LOTNO. BLOCK TRACT , <br /> DESC. <br /> OWNER ADDRE93 ZIP PMONE <br /> ,!�,J���z� � �9.��,��,J��y Q9�k��.�' �,�� � ��.�.�-r� <br /> TENANT NAME C NTACT FOR PE MIT PHONE <br /> f1��� f�i9eLi�A� I <br /> CONTRACTOR F"�l� r �'C�'x�y�� ADDRESS . �pX ��3� ZIP CONTR.UCENSE/ <br /> f <br /> v�`�td�.�15� <`•Jt/LC�G+r91�yy <br /> PHONE yo�-3�7`�:i�3�/ ��1 it'i i `�� r..�� �'j/�y/oy <br /> PROPOSED USE OF BUILDIN6 Building Mechanlcal Addition HEAT SOURCE <br /> PERMIT R Combinatlon Plumbing WORK B AlteraUon � ElecUlc <br /> TYPE �� Demolltian Slgn TVPE ❑ New Gaa <br /> � SprinY,ler U Repair/Maint. Other <br /> CONTRACT PRICE OF WORK ��n� CITY OF EVERETT LOCAL SALES TAX CODE IS 710! <br /> WORK DESCRIPTION ��QI�GL � �'�� �� �C/ LJn/x l�- /`f,tlgT� <br /> v <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYf'E OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) AIC—AIHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASH�R METALFIREPLACFJSTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVE�i tR GAS PIPING <br /> SINK(SERVICE/BAR/MOP/LTC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBV CERITIFV THAT I HAVE READ AND[%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROViSIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILI BE COMPLIED W'TH WHETHER SPECIFIED HEREIN OR <br />� NOT. 7HE GRANTING OF A PERMIT DOES N0T PRESUME TtJ GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />. STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> 1��� ✓ %r�----��" ��/9�0� <br /> Signa�ure of OwnedContractor/A onzed Agent at <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />