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i -- --- <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> 3 3a -o� <br /> I� SI7E ADDRESS PARCEL TAX I.D. # P RMIT p <br /> /�/IG Cl/� f/ i)r:� �- ✓..'�7l �IP1n�' � �3 - � <br /> iLEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AOORESS ZIP PHONE <br /> (_-�: ��,/. , C �`7rrtTj.�� /f�l(i !�l¢f OC ��;•rr7ll��A '��4'1�:-/P�7i <br /> /j1�-1�1 -.SZs'r <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> ro�c��,��- <br /> CONTRACTOR L 1 La�� r�•d� �.:�.1t /i� /�•e ADORESS <br /> ZIP CONTR. LICENSE p <br /> � i <br /> V <br /> PHONE � <br /> 3G�� - l._s�. ��ti 7'� � �E'lC 12�b ��. /�11! IJ�a i Y c✓�//i, k�� �Q2 J/ <br /> PROPOSED USE OF BUILDING Building Mechanicfll Addllion HEAT SOURCE <br /> PERMIT �Ry Combinatiori Plumbinq IWORK R Alterallon � Electnc <br /> ��-.{' �� TYP[ �–( Demolilion,�� Sign TYPE D New Gas <br /> �U ��� v Sprinkler U Repair/Maint. Olher <br /> CONTRACi PRICE OF WORK CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 — I <br /> WORK OESCRIPTION <br /> PLUMBING MECHANICAL I <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIX7URE OR ITEM <br /> _ WATERCLOSET(TOILET) A/C–A/HANDLINGUNITS <br /> _ BATHTUB FORC[D AIR SYSTEMS <br /> __ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNITHEATERS <br /> _ KITCHEN SINK 8 DISP03AL CLGTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE I <br /> URINAL <br /> i = = FIREPLACE INSERT <br /> ORINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> I _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK (S[RVICE/BAR/MOP/ETC.) ' EXHAUST FAIJ <br /> _ OTF�F�R/_� _ OTHER <br /> -- � �� 1 <br /> — _ �� — _ <br /> 7 <br /> I HEREBV CERITIFY THAT I HAVE FlEAD AND EXAh11NED THIS APPLICATION AND KNOW"HE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDIIJACES GOVERNING THIS TVPe OF WORK l5'ILL BE COM1IPLIED WITH WHETHER SPEGFIED HEREIN OR I <br /> NO'. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANV OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFURMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPEF71'TO P[RFORM1I THE WORK FOR YVHICH APPLICATION IS IdADE AND I COMPLY W'ITH THE STATE <br /> COIJTRACTORS LAW 78 27 RCW nND 296200 WAC. <br /> i' <br /> Signature of OwnenConlractoUAWhonzed Agent Dale I <br /> DE81T & CREDIT CARDS ARE NOT ACCEPTED <br /> i� <br /> i Br, <br />