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� <br /> �PERMIT APPLICA710N <br /> CITY OF E�/ERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 l�3�S_ 0/Q <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT tt <br /> � o �'�er re �hul� o6a �Soo � ( Boaia �o, � <br /> �� LE LOTNO. BLOCK TRACT <br /> ; DESC. <br /> � p�oR ^ a i n y ,a AD�RESS 21P PHONE <br /> � a1{� ����d � 4 ��aS ���0 8a � � <br /> ' s�yQ�T N � � �/ CONTACT FOR PERMIT o 6 -� I y PF�Q F3 <br /> i �3ike �or0 SJUf e �Y}� <br /> i I �q�e s.�e1-� �aS� y �- o �'y` -- <br /> ICGNTRACTOR �V(�$_��p1�.��re AO�RESS 6'�L�(�' J,.�� � �h ZIP CONTR.LICENSE M <br /> ro�e c��o��� �j� � , s7'�dkP � r�-�o r�� �-l.`�(/F/2(=�0 �f'Gi�' <br /> i PHONE ��� �/ r� O L� LlJ/� q J�o a F <br /> C tS � <br /> ! PROPf�SED U E OF BUILDING Building Mochanical AddiGon HEAT SOURCE <br /> I n�i.C` ` � PERMIT R�.{ Combination Plumbing WORK Alteration Eleclric <br /> I r � 1YPE �j Demolili0n Sign TYPE New � Gas <br /> I U Spnnkler RepalUMaint. Other <br /> i <br /> i CONTRACT PRICE OF WORK a q o �Q n � CITY OF EVERETT LOCAL SALES TN(CODE IS 3105 <br /> 4 <br /> � WORK DESCRIPTION <br /> � <br /> �I <br /> PLUMBING MECHANICAL <br /> � NO. I TYPE OF FIXTURE OR ITEM I NO. TYPE OF FIXTURE OR ITEM <br /> I WATER CLOSET(TCi�ET) A/C-A/HANDLING UNITS <br /> I BATHTUB FORCED AIR SYSTEMS <br /> LAVATOR'f(WASH BASIN) HEAT PUMP <br /> � SHGVlER UNIT HEATERS <br /> KITCHEN SINK S DISPOSAL CLOTHES DRYER <br /> DISMIJASHER R.4NGE HOOD <br /> ! LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKiNG FOUNTAIN GAS FIREP'v,.^.E <br /> FLOOR�RAIN GAS RA�1GE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN� <br /> II = OTHER — aT�� eQ 1 � <br /> �� 0� <br /> . i t'.ER'c�V CERITIFY THAT I HAVE READ AND EXh�dINED THIS APPLICATION AfJD KNOW THE SAIdE TO BE TRUE AND CORRECT. ALL <br /> PRCVIS�ONS C�F LAYJS AND OHIDINFC'cS GOVERNING THIS TYPE OF WORK WII.L BE COMPLIED WITH WHETHER SPEqFIED HEREIN OR <br /> � 'iOT. THc GRANTL'�1G OF A PERIdl7 DOES IJOT PRESU!dE TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � 5 i i�TE OR LOCFL LH'P!REGULFTIN CONSTRUCTION OR THc PERFORIdANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> � NER OF' IS PROPERTY T ORIA THE'NORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH TfiE STATE <br /> �CO i �R � "' 7017 W � 296.200 WAC. <br /> I 5 ia ure of mor/Cont ctodAut`�onzed Agent c �� `a� Date 1I� <br /> DEBIT & CREDiT CARDS ARE NOT ACCEPTED <br />