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P�RMIT APPLICATIO�V <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.# PERMIT f! <br /> _. �c. > � 2 �G Bd3ia-cy5 <br /> LEGA LOT NO. BLOCK TIR'A T <br /> DESC. `Z Z !� L —� � <br /> OWNER ADD SS ZIP PHONE <br /> �ci�1-�� � I� . � c��e � � � C���i � 4 � `� g'1c'`"� yZS 34a-sb 6 <br /> TENANT NAME CONTACT FOR ERMIT PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE p <br /> I <br /> PHONE <br /> i <br /> PROPOSED USE OF BUIL�ING Building fl Mechanical Addition HEAT SOURCE <br /> ,� PERMIT CombinaQon H Plumbing WORK � NleraOon i D Electnc <br /> 6(11� TYPE Demolillon V Sign TYPE New C] cag <br /> Sprinkler RepaldMaint. L 01her <br /> CONTRACT PR��F.OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS J10S <br /> WORK DESCRIPTIUN (�� <br /> �2W �c � �,�1�-u� C7Cl� o�c�� <br /> i <br /> r <br /> PLUMBINc; MECHANICAL <br /> NO. TYPE OF FIXTURE 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 BASINI HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACEISTOVE <br /> URINAL FIREPLACE INSERT <br /> I = DRINKING POUNTAIN = GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> � SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> i _ OTNER = OTHER <br /> I __ — <br /> � <br /> '� I HEREBY CERITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF N'ORK WILL BE COMPLIED WITM WHETHER SPECIFIED HEREIN OR <br /> ��� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � STA?E OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZE�BV THE <br /> � OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> ICONiRACTORS LAW 18.27 RC'N AND 296,200 WAC. <br /> ,i �r.L,L1S���_� �/O � �- / Z— � C — � � <br /> .,, Signature of OwnerlContractor/Authonzed Agent Date � /� 1 <br /> ! � J <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />