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� PERMIT APPLI�ATION <br /> (::�Ti' OF EVERETT PERMIT SERVICES <br /> 3::00 CE6AR STREET, EVERETT, WA 98201 <br /> 425-?5�'-Ei810- FAX 425-257-8857 � ` <br /> �s ai -v <br /> SITE ADDRE:�S PARCEL TAX I.D.# PERMIT� <br /> Cr5 Q � '�V��,1s;�::�i!-1 In��a`t Bo�i g � �Ooo 00� op S� �Q _ - S <br /> LEGA LATNO. BLOCK TRACT <br /> DESC. __ <br /> OWNER ADDRESS 21P PHONE <br /> 35�+���� s�� � t� � o acas sT. s��� �,.�A �Si�a <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> (�(-J{�j {-�jJ$cG2i1.L St-�.tN F�oW�� Z�LZZ71tZ2. <br /> CONTRACTOR Tj4,�� A�DRESS�'7 0-rj L`T�- F��- 5• ZIP CONTR.LICENSE# <br /> �-R� c` �V��!- `� T�S'xS'��3uC�5 <br /> PHONE <br /> ���34 <br /> PROPOSED USE OF BUILDING n Building MeChaniCal Addltlon NEAT SOURCE <br /> PERMIT I S Combinalion Plumbing WORK Alferalion Q ElecVic <br /> ���I �-FpJSc TYPE H Demolition C�Sign 1YPE New �j Gas <br /> LJ Sprinklef RepaidMaint L� Olher <br /> CONTRACT PRICE OF WORK �pp � CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> WORI(DESCRIPTION <br /> 6N S'CP�- or-� tnl�,(_ S1C�/J , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C-,4lHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUN�RY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACEISTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I 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 ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMP�IED WITH WHETHER SPECI'rIED HEREIN OR <br /> NOT. THE GRANTING OF A PERPAIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC S LAW'IB.27 RCW AND 296.200 WAC. <br /> _ g•21 •�'a <br /> Signat e of O n Conir tor/Authorized Agent Data i/z <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />