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P 'RMIT APPLICATIUN <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 MiT a <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> O�/ I(/ GA" �'Y�Q/Q� J/.G� �ef^ '"I�/ �� 21P PHONE — <br /> TENANT AME CONiACT FOR PERMIT PHONE <br /> CONTRACTOR A��b I� K P�(/�'� �S ADDRES9 �.s�i2 G !+S'G � ZI�� CONTR.UCEN9E N <br /> r <br /> PHONE Yz s �y2� /�/ J � �a�fSLK �11 <br /> PROPOSED USE OF BUILOIN6 Bullding �echanical Adtli�on HEAT 90URCE <br /> PERMIT RI-.1 Combinallon Iumbing WORK Alterallon ElecVic <br /> 7YPE �._j Demolition Slgn TYPE New � Gas <br /> �] Sprinkler RepalrlMelnt. Other <br /> CONTRACT PRICE OF WORK � QpG, '�� CITY OF EVERETT LOCAL 9ALE9 TAX CODE 19]70S <br /> i <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FU(TURE OR�TEM <br /> WATER CLOSET(TOILET) AIC—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> �ISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING 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 HEREBV CERITIFV THAT I HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING Of A PERMIT DOES NOT PRESUA4E TO GIVE AUTHORITY TO VIOUITE OR CANCEL 7HE PROVISION OF ANY OTHER <br /> 5?9TE OR LOCAL U1W REGULATING CONSTRUCTION UR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED B:'TNE <br /> OWNER Of THIS PROPERN TO PERFORM THE'NORK F'OR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTO LA 18.27 RCW AND"96.200 WAC. <br /> � - /��� 6/4� ' <br /> Signeture of w er/ ont•actor/Aulhonzed Agent al �. <br /> L DEBIT 8 CREUIT CARDS ARE NOT ACCEPTED <br />