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PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES 'I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810- FAX 425-257-8857 y`}��� / , <br /> �� � <br /> SITE ADDR�SS I PARCEL TAX I.D.# PERMIT r+ � <br /> ,'! � <br /> � `'� ' . l ��il- _l' �s`� l! � ��1 '� <br /> LEGA lOTNO. BLOCK TRACT i <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �rY�i1 ���'�'�� //%� �t�//c� �'�. �e<<.✓� t1 >�ZQ/ �ZS ?_'��'-5�7� <br /> TENANTNAME CONTACTFO ERMIT PHONE <br /> � <br /> �Ll;l.1 � ��1� ��)ll�S �`����(G� ��.7 G���%- ��-�� � <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> i <br /> C'f�7 i�.S�"ara�i�rn r �nr�t/�U���� 2 !j /G,?.��/Jr S�'�� ��;-'OO <br /> PHONE r / � 7���� S 1E'1�CG� � <br /> C�-%`-J 7�.�' ('J ��`/ <br /> PROPOSED USE OF BUILDING �uilding Mechanical n Addition HEAT SOURCE <br /> PERMIT ombination � Plumbing WORK r-s Alteration Q�Elecvic <br /> � � , 7YPE Demolition Sign IYPE � New �j Gas <br /> ���f"f� Sprinkler XJ RepairlMaint. lJ Other <br /> CONTRACT PRILE OF WORK �'�GlDC I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i IWORK DESCRIPTION -i <br /> ���f� ('.�j iy"�; t"!��f f7 L�7 `,_(_/i7�(��t / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILETj A/C–A/HANDLING UNITS <br /> 1 BATHTUB _L FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> / DISHWASHER T RANGE HOOD <br /> LAUNDRYTRAY 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(5ERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> I <br /> — — i <br /> I I HEREBY CERITIFV THAT I HAVE READ AND EXAM�NED THIS FPPLICATION AND KNOW THE SAIdE TO 8E TRUE hND CORRECT. ALL I <br /> PROVISIONS OF L4b'JS AND ORIDINACES GOVERNING THIS TYPE OF WORK WIL�BE COMPLIED WITH 1'VHETHER SPECIFIE�HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESU�dE TO GIVc AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER I <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTIOIJ OR THE PERFORAIANCE OF CONS7RUCTION. THAT I AM AUTHORIZED BY THE ' <br /> OWNER OF THIS PRCPERTY TO PERFORh7 THE l'JORK FOR CJHICH APPLICATION IS A1A�F AND i COMPLY WITH THE STATE � <br /> CONTRPCTORS LAW 1�27 RCIV AND 296.".00 1NAC. �i � <br /> i <br /> Signature o(OwnroContractodAuthorizetl Agent Date �. <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTFD <br />