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— ---- j -- – — — <br /> co — flz—o <br /> � PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8f110 – FAX 425-257-8857 <br /> SITE AODRESS I PARCEL TA7(I.D.# PEPMiT p i� �� I' <br /> .I�- �f � i <br /> = "` c"� 'Iro �� -9 � . <br /> LEG L l0T N0. BLOCK TRACT <br /> DESC. <br /> OWNER � DpRESS ZIP PHONE <br /> Lrrr%ssa MticA�vv�ti zo �j C cAs�na �� fiF �u.nro-.+t �6'�6� ��4's <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> —r— <br /> �ti„vp��„�. �a s r�,� �.�� MY�,�1 ��-r— �r=� — �s�K/ <br /> CONiRACTOR ���,_,�� C�7 � ADDRESS ZIP CONTR.L�CENSE If <br /> �' ��'r�V F/� S� T� �3 �yl�Hw�d WN17E uL `j�6 cJ <br /> PMONE �A �� <br /> c/�-�" � �Uu - �a �-� � '�/�, � o r <br /> PROPOSED USE OF BUILDING Building �Mechanlcal I Atldition HEAT SOURCE <br /> PERMIT R Combinatior� Plumbing WORK � Nteration � Electnc <br /> I IYPE D Demolition Sign TVPE New Gas <br /> �� Sprinkler RepainMaint. Olher <br /> CONTRACT PRICE OF WORK � ,r-rn� CITY OF EVERETT LOCAL SALES TAJf CODE IS 9105 <br /> // i �. <br /> WORKDESCRIPTION i!' �� ` ��Q �ih�/� ���^ C� 11�p,� r .� <br /> b >��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILE'i) A/C–A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTIIES DRYER <br /> DISHWASHER R4NGE HnOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE ! <br /> URiNAL FIREPLACE INSERT � <br /> i DRINKING FOUNTAIN GAS FIREPLACE � <br /> I = FLOOR DRAIN = GAS RANGE <br /> BACKF�OW PREVENTER GAS PIPING � <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I — — — <br /> I — — <br /> I HEREBV CERITIFY THAT I HAVE READ AND E.'WAIINED THIS APPLICF.TION AND KNOW THE SAME TO NE TRUE AND CORRECT. ALL <br /> � PROVISIONS OF L4WS AND ORIDINACES GOl'ERNING THIS TYPE OF WORK WILL BE COMPLIED WITH LYHETHE7 SPECIFIED HEREIN CR �. <br /> NOT. THE GRANTING OF A PERAiIT�OES NOT PRESUti1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL 7HE PROVISION OF ANV OTHER �i <br /> � STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TME PERFORI,'ANCE OF CONSTRUCTIUN. TNAT I AM AUTHORIZED BY THE I <br /> ' •'7VJNER OF THIS PROPERTY TO PERFORM TNE WORH FOR WHICH APPUCATION IS MADE AND I COMPL'I WITH THE STATE � <br /> '� CONTRACTORS LA1V 1A 27 RC14 AND 29§ 0 YAC. I <br /> ' � ,''-�LC��� 6���� � <br /> � Signature of OwnerlContractouAuthonzed Agent Date <br /> I _ DEBIT & CREDIT CARDS ARE NOT ACCEPTED _ I2 ! <br />