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, PERMIT APPLICATI� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 's200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857 <br /> I� C��/Co2 � oT!/ <br /> SITE ADDRESS ' � ` b�A�E��I.D.A bO � U U PERMi7 i��� _�O� <br /> L <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER _ ADDRESS ZIP PHONE <br /> .I.� oc, �' ,�vx l3� i��:�.� <br /> TENANT NAME CONTACT FOR PERMIi PHONE <br /> � C� / ZG, oS /3r//.� , -�l�i �C �'/2S'' S�L�-�L � <br /> CONTRACTOR ADURES���f�; ��� ��P CONTR.LICENSE N <br /> �j� d1 S / �/ �.vSd (.��L ' <br /> PHONE /'L � �,/,��ti p �� � � rU S� '/ �O �0 <br /> PROPOSED USE OF BUILDING n Building fl Mechanical Addition I MEAT SOURCE <br /> PERMIT K Combination NK Plumbing WORK R AlleraGon � Eleclnc <br /> TYPE �__( Demolition LJ Sign TYPE D New Gas <br /> LJ Sprinkler � U RepaidMainL Other <br /> CONTRACT PRICE OF WORK /O' p�jv CITY OF EVERETT LOCAL SALFS TA%CODE IS 3105 <br /> ( <br /> WORKDESCRIPTION /���r l//� � � � % �T �� ` /�B n <br /> a �, /L � l., <br /> QC.�/ L/� ;��- t <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM �D. � 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 HEATERS <br /> Z. KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOU�TAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> � BACKFLOW PREVENTER _ GAS PIPING <br /> � SINK(SERVICE/BARIMOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> t — — <br /> I � I <br /> I � <br /> II HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF lAWS AND GRIDINACES GOVERNING ThIS NPE OF WORK VJILL BE COMPLIED WITH WHETHER SPECIFIED HcREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> ' STATE OR LOCAL LAW REGULATING CC^lSTRUCTION OR THE PERFORMANCc OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE\VORK FOR WF11CH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS WW 1&27 RCW AND .200\NAC. <br /> � �,����1� ��/�'/���/ �/` Zv -D`/ <br /> ISi nat� ,�.of�anw/Contr ctorlAuthonzed A - t �- Date II <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED I <br />