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;� P�RMIT APPLICATI�N <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> •Z �j Z r Go L�y �,ti: <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT /' <br /> /�v <br /> LEGA LOTNO. BLOCK TRAGT <br /> DESC. <br /> OWNER ADDRE55 21P PHONE <br /> a�-��,1� P-,,J�s zs 2 i c� �,�� ,� ,ti <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �st� �zL,��� I J�s� �A�;�,��� a� �-��-y2� y <br /> CONTRACTOR ADDRESS 21P CONTR.LICENSE N <br /> � 1��4 �>/IiL ��5i��� �SY�S-S%T�/�/,� S SC:4 wN �'71YuI' l`7�dI'N�/elf�2 <br /> PHONE <br /> PROPOSED USE OF BUILDING Building f7 Mechanical Additlon I HEAT SOURCE <br /> PERM4T B Combination H Plumbing IWORK B AlteraUon � Elecvic <br /> I TYPE D Demolition IGJ—S+gn TYPE D New Gas <br /> U Spnnkler U Repair/MainL Other <br /> CONTRACT PRICE OF WORK �7� Q � — CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> G <br /> WORK O(:SCRIPTION <br /> ltis ���r C�l wn i� s'�c,a, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE 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 HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNORYTRAY WATER HEATER <br /> CIOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLPCE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> � BACKFLOW PREVENTER GAS PIPING <br /> i _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> i HEREBV CERITIFV THA7I HAVE READ AND EXAIdINED THIS A?PLICATION AND KNOW THE SAIdE TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF'J�WS AND ORIDRJACES GOVERNING THIS TYFE OF WORK WILL BE COMPLIED WITH WHETHER SPEGFIED HEREIN OR <br /> .'JOT. THE GRANTING OF A PERMIT DOE i NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL TH�PROVISION OF ANY OTHER <br /> � STATE OR IOCAL LAW REGULATING CfiNSTRUCT10:J OP.THE PERPORMANCE OF CONSTRUCTION. THAT I Ald AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PE��ORIA THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> �I CGNTRACTORS 11��18.27 RCW r.IJD 296200 WAC. <br /> I 5�/ure o OwnerlContractor/Authonzed Agent Date I `/L <br /> DEBIT 8 CR EDI T C A R D S A R E N O T A C C E P T E D <br />