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P�RMIT APPLICATIOnI <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SIT ADDR SS PARCEL TAX I.D.#� PERMI7 p <br /> � ,�.�'- `� ' . �ut..� • � ���� - 369 -va � -o� �oyos-occ� <br /> LEGA LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER ADDRESS <br /> i 21P,��HONE <br /> � � f�- �p� <br /> �� � ���J���' t<��i�>l?9 �� a 2�-l�� �'✓9��I <br /> TENANTNAME I CON7ACTFORPERMIT PHONE <br /> CONTRACTOR �N���_ ADDRESS ZIP CONTR.LICENSE N <br /> PHONE <br /> PROPOSEo USE OF BUILOING I f"1 Building D Mechanical Addition MEAT SOURCE <br /> � f��2j��� PERMIT �_{ Combination U Plumbing IWORK R AltereRon � ElecUic <br /> TYPE �,.1 Demoiition U Sign TYPE C�New Gas <br /> LJ Sprinkler U Repair/Maint. Other <br /> CONTRACT PRICE OP WORK /,��,�� �- CITY OF EVERETT LOCAL SALES TAX CODE�S 3705 <br /> ca� <br /> WORKDESCRIPTION/'r3l�.=;)LL��� LI-1-� (�,�-f�� SHFfl IrS , 1� � � � <br /> t <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNIT HEA7ERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HUOO <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE�STOVE <br /> _ URINAL FIREPIACE 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 <br />, I HEREBY CERITIFY THAT I HAVE READ AND EkAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND OftIDINACES GOVERNING THIS NPE OF WORK 441LL BE CUMPLIED WITH WHETHER SPECIFIED HFREIN OR <br /> NOT. THE GRANTIN3 OF A PERMI7 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCt OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE IM1'ORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRA�TORS LAW 18.27 RC AND 296.200 WAC. <br /> y'� ��,.� � -'' .c�.+"- ��/�-/'i-f' J l���'u � <br /> Sig aWre of OwnedContractor/Authonzed Agent Date <br /> DEBIT 8 CREDIT CRRDS NRE tJOT ACCEPTED /L <br />