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C� — ��—oy � <br /> PEh2MIT APPLICATI4N � <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 �EDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810 - FAX 425-257-8857 „ , � <br /> i <br /> SIT ADDRESS n�e �/�y��'� PARCtL TAX I.D.# PERMi7 tt <br /> � � C�ld y �, , �-�r � ���5 �r� �, s�ya� a�5 <br /> LEGA LOTNO. BLOCK � TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �;7 � �il^L(� ' 1 � �i��ei�r �G�U C�1,1� '7i �.�/�r'7/` �'Y���tJ �17-���, <br /> TENANTNAME CONTACTFORPEF2MIT � PHONE <br /> ,���-,��ti�, fle����� � �����y�/�,�'�� ��6� ��y—/���; <br /> CONTRACTOR �//� A�ORES � ZIP CONTR.LICENSE# <br /> PHONE <br /> PROPOSED USE OF BUILDING Building MeChanical Addition HEAT SOURCE <br /> PBRMIT � CPmbination� Plumbing IWORK R AltPrauon I � Eiectnc <br /> TYPE Demolition Sign TYPE � New Gas <br /> S tinklB� Re aidMainL Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXiURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A!C—A/HANCLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUIeIP <br /> SIIOWER UNIT HEATERS <br /> KITCHEN SINK&D�SPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNORY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRA�N GAS RANGE <br />� BACKFLOW PREVENTER GAS PIPING <br /> _ S�NK(SERVICE/BARIMOP/ETC.) EXHAUST FAN <br /> OTHER OTHER � T�N <br /> — —i _ <br /> I —I <br /> i <br /> I I HEREBV CERI�i IFV THAT I HAVE READ AN�EXAh11NED THIS APPLICATION AND kNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF:AN/S AND ORIDINACES GCVERNING THIS TYPE OF WORK VJILL BE COMPLIED WITH L'VHE�HER SPECIFIED HEREI�D ' <br /> NOT. THE GRANTING JF A PERh11T DOES NOT PRESUt.tE TO GIVE AUTHORITY TO VIOWTe CR CANCEL THE PROVISION Or AN"OTi1E, <br /> i STATE OR LOCAL LAV REGU(.ATING CONSTRUCTION OR THE PERFORMANCE CF CONSTRUCTION. THAT I AM AUTHORIZEO"BY THE <br /> � OINNER OF THIS PROPERTY TO PERPORM 7HE WORK FOR LVHICH APPLICAT�ON IS MADE AND I COMPLY WITH THE STATE <br /> ' CO�PA/RAC i ORS LAW 18�7 RC AND 296.200 WAC. / <br /> J�"`C��.y l�`1'e � �/r 7�` � I l <br /> "Signature of Own r tractor/A onzed Agent /Date— � �� <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED � <br />