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P`tRMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 r7 <br /> 425-257-8810- FAX 425-257-8857 �O a -�-7 <br /> /1J6lZTH 1� I�� <br /> ' SITE ADDRESS PARCEL TAX I.D.# PER61R u J <br /> ' D C 60.:G�1 ^ G� <br /> , LEG�LJ LOT NO. BLOCK TRACT <br /> DEaC.� <br /> , OWNER ADDRESS ZIP PHONE <br /> � TENANT NAME I CONTACT FOR PERMIT PHONB <br /> i <br /> i <br /> ' CONTRACTOR ADDRESS ZIP CONTR.LICENSE p <br /> PHONE <br /> i _�t�f�� I�l'{ ([JcST -AI Jrv��l�� G <br /> i PROPOSED USE OF BUILDING Buildiflg � Mechanical AddiGon HEAT SOIIRCE <br /> , PERMIT R Combination Plumbing WORK g Alleralien I7 Electric <br /> i TYPE D Dem01ili0n Sign TYPE D New � Gas <br /> ; U Sprinkler U RepairiMalnt. Other <br /> � CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> �, WORK DESCR�PTION <br /> i PLUMBING MECHANICAL <br /> � NO. I TYPE OF FIXTURE UR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ,� WAT'cR CLOSET(TOILET) A/C–AIHANDLING UNITS <br /> �-1 BATHTUB FORCED AIR SYSTEMS <br /> , � LAVATORY(WASH BASIN) HEAT PUMP <br /> �, SHCWER UNITHEATERS <br /> � KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> , DISMPlASHER R,4NGE H000 <br /> _ LAUNDRY TRAY ,� WATER HEATER <br /> CLOTHeS 4VASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/IAOPlETC.) EXHAUST FAN <br /> OTHER OTHER <br /> — I — — <br /> I HER'c8Y CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATiON APlD KNUW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROV15�0'�S OF IA:YS MlD ORIDINACES GOVERNIIJG THIS TYPE QS WORK WILL BE COMPLIEO WI7H WHETHER SPECIfIED HEREIN OR <br /> NOT. THE GRktJTItJG OF A PERMIT�OES NOT PRESUI.IE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CGNSTRUCTION OR THE PERFORf�fANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> . OYlNER OF TNIS PROPERTY TO PERFORll,THE WORK FOR VJHICH APPLICATION IS'rAADE AND I COMPLY WITH THE STATE <br /> CONTRACTO�RS LAN! iB.27 RCN AND 296.200 WAC. <br /> I7C/1 ( ol/fn S SS-�- � � <br /> SignaNr oYOvmer/ConVaclor/Authonzed Agent Dale <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />