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l <br /> NERMIT APPLICATION <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 k <br /> � ���3 - a r/�o� �d . Mo3o�-o,a�/ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS 21P PHONE <br /> Ga� l-�a I ( N�a3 �- C�u �-1 f� ,P� qsa�3 yas as9-/a <br /> TENANT N E CONTACT FOR PERMIT PHONE <br /> �a �i ( / �/,�S �S'y-/2E�' <br /> CONTRACTOR �N Q `'GN Ce ADDRESS 21P CONTR.LICEN8E N <br /> �� P P.D , Ro.� l$3� <br /> PHONE eN�Qb���s�M9 <br /> s 5 O -i� l�+l� S�U�uS GJa , qg�Ss� <br /> PROPOSE�USEOFBUILDINO pERMIT � Sprink�eallon �Plu bing I WORK � RePrs�81n' HEATBEectric <br /> • '�,Jw� /'�u� TYPE Demolitlon [� Slpn TYPE Naw �Gae <br /> ���Q 't`LW� U l L� Other <br /> CONTRACT PRICE OF WORK aGO ' CITY Of EVERETT LOCAL SALES TAIf CODE IS�10! <br /> WORK DESCRIPTION <br /> C� f� �Gl� ek��-�r� ���ec -� V ��c �Uat�� �Pq7� <br /> PLUMBIN(3 MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) P�C-A/HANDLINC,UNITS <br /> BATH7U8 FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 6 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY = WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACFJSTOVE <br /> URINAL FIREPLACE INSERT <br /> ORINKING 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 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAW3 AND ORIDINACE:S GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED MEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TFIE PROVISION Of ANY OTHER <br /> STATE OR LOCAL L4W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTIUN. THAT I AM AUTMORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM TNE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRA_-�27 �W D 2 .20 WAC. <br /> ��� � -�S <br /> Sign tu e o nerl a trecto u ori:ed ent ale <br /> DE T 6 CREDIT CARDS ARE NOT ACCEPTED <br />