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i � <br /> PERMIT APPL�CATION � <br /> SERVICES <br /> CITY OF EVERETT PERMIT I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-8810- FAX 425-257-8857 <br /> .� / CC� �G�. /�IJ� � <br /> SITE ADDRE55 PARCEL TAX I.D.# I PERMIT u <br /> h1oyo3 -OfG <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PNONE <br /> �tll �, S�,�l h� ss,��,� �/,u i z � �y �o/ti�, ,�ti� , <br /> TENANTNAME CONTACTFOR PERMIT PHONE <br /> I <br /> � /�i�c.� �_'� 3 a a s-�o�v I <br />� AUDRE55 ZIP CONTR.LICENSE p <br /> CONTRACTOR ���� � <br /> Q� --��, <br /> � ��l�C�f�—.�_`> z�.� <br /> PHONE �' ��'� <br /> �`� �l �l .2 U� "� �. .�L% ���•t,� <br /> r— BUildin MKChanIC31 Addllion HEAT SOURCE <br /> PROPOSED US OF BUILDING D 9 <br /> PERMIT I ) Combination Plumbing WORK Alleration Q Electnc <br /> TYPE g Demolition Sign ITYPE New �j Gas <br /> Sprinkler RepaidMainL U Olher <br /> CONTRACi PRICE OF WORK CITV OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ �C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPIACE INSERT <br /> DRINKWG FOUNTAW _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> I _ SINK(SERVICE/BAR/MOPIETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> — I <br /> — I <br /> i <br /> � I HEREBY CERITIFY THAT I HAVE READ ANO EXA611NED THIS APPUCATION AND KNOLV THE SAA7E TO BE TRUE AND CORRECT. ALL i <br /> PROVISIONS OF LAVJS AND ORIDINACES GOVERNING THIS iYPE OF WORK WILL BE COMPLIED WITH tiYHETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTIWG OF A PERAIIT DGES NOT PRESUAiE TO GIVE AUTHORITY TO VIOLATE OR CANCGL THE PROVISION OF ANY OTHER II <br /> � STATE OR LOCAL LAW REGULATING CONSTRUCTION OR 7HE PERFORMANCE OF CONSTRUCTION. THAT I AA1 AUTHORIZED BY THE <br /> IOWNER OF THIS PROPERTY TO PERFORtd THE�VORK FOR 1VNICH APPLICATION IS M11ADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND"�6"00 W C. <br /> � ✓ _�� �� � � �5 -d y I <br /> Siynai� e of Owner ContractorlAuthonzed gent Dale <br /> i, <br /> i DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />