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6 -ai-�_ <br /> , ------- ---- -- - - - <br /> PERMIT APPLICATION <br /> GITY OF EVERETT PERMIT SERVICES <br /> 3200 CCDAR STREET, EVERETT, WA 88201 <br /> 425-257-8810—FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TA%1.0.M P[RMIT t <br /> 3�1 L LC.`-�i r.lp �D . I � - - � '1 <br /> LEGAL LOTNO. BIOCK TRACT <br /> DESC <br /> ONMER ADDRESS � ZIP PHONE <br /> � � , - � �_ � ��� �:;� � �,- ��riD� <br /> !, ; <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> Pr.c� iic�7y t�ur�intN I C:v.� '�2�� 3�Iti� -c�`�`� <br /> CONTRACiOR ADONE99 ...�, � ,l, 21P CONTR.LICEN9E� <br /> n'�1K[..�`,I LLu1t��1Jl_1 ti �41��ll.nli_•� f•l.> �C�X�C 1� �. <br /> .Cc�rti.E ��`:,i �'_� Mil«SP�4HOKr1 <br /> PNONE <br /> ��% r� -� 1� �(ji_��. 1 <br /> PROP09ED U9E OF BUILDINO f7 Building � Mechamcal f'1 AdAmon HEAT SOURCE <br /> ( PERMIT �-� Combination Plumbing WONR �Iqr Anernuon R Ekciric <br /> TYPE j � Demoli6on Sgn TYPE �..J New �.j Gns <br /> fJ Sprinkler LJ Rep�idMaint U Other <br /> CONTRACT PRICE OF WORK g L��nh � CITV OF EVERETT LOCAL 9ALES TAI(CODE IS�105 <br /> WORN DE9CRIPTION <br /> PLUMBING MECHANICAL <br /> H0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR I1EM <br /> WATER CLOSET _ AIC-A/HANDLING UNITS <br /> BATHTU6 FORCFD AIR SYST[MS <br /> LAVATORVIWASH�ASIN� _ HEAT PUMP <br /> � SHOWER _ UNIT HEATERS <br /> KITCHGN SINK 8 DISPOSAL CLOTHES ORYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER ME7AL FIREPLACE/STOVE <br /> URINAL FIREPl4CE INSERT <br /> DRINHING FOUNTAIN vA5 FIREPLACE <br /> FLOOR DRA�'J GAS RANGE <br /> BACKFLOW PREVENT[R GAS PIPING <br /> � SINK �SERVICE/BAR/MOP/ETC ) IIt�P�'� S�n�k __ E%HAUSTFAN <br /> OTHER HH�.�D S�� K — OTHER _ <br /> — — l'ri��ry 5��� — - <br /> -- � — <br /> �u:...i: �in��. <br /> I HF-Rf.B1'CFRIIIF V iHAT I HAVf READ ANC)P%AMMED THIS APPI ICP.TION ANO KNQV,'THE SAME TJ 9E TRUE AND CORRECT AlL <br /> PROVISIOM1S Uf IAWS ANfI ORIDINAf,f:ti GOVCRNING THIS TVFL Jf��VORK NJII L BE COMPLIED 1MTH NMETHER SP[CIFlED NEREIN OR <br /> NOT 7HC GPANiING O(A PfRM�T Ik)f 5 NUT PRfSUMC TO GNE AUTHORITV TO VIOIATE OR CANCEL THE PROVISION OP ANY OfNER <br /> STATE OR l0(,Al L AW RfGJLniMG CONS7RUC110N OR THE PERFORMANCF OF CONSiRUCTInN THAT I AM AUTHORIZED flY THE <br /> ONMFR Of THIS PHOPfRIY TO PCRfORM THE WURK FOR WHICN APPLICATION IS MADE AN�I COMPLV NATH THE STF7E <br /> CONTRAC RS IAIN Iuf7 RCW 49fi 200 WAC <br /> l� i t,�. �/2��0�{ <br /> �Signature o r ont�4-odAutho zed Agenl Date <br /> �\D BIT& CREDIT CARDS ARE NOT ACCEPTED <br />