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l�tRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 G����� <br /> S�`��� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMi7 z <br /> i i ._ <br /> /; `� 'i.� ;: iC/ :'��;� <br /> �EG.4� LOT NO. — BLOCK TRACT <br /> �ESC I <br /> i OWNER . ADORESS 21P PHUN� <br /> / <br /> ' � i �(. '' ��/ <br /> f?.� _ � <br /> i TENANT NAME �" � I CONTACT FOR PERMIT PHONE <br /> I <br /> ! CONiRACTOR AUDRESS ZIP CONiR.LICENSE p <br /> � PHONE �).� � <br /> � �,VSK 1(�( C !)r )IMi�`. <br /> I PROPOSED USE OF 6UILDING Building D Mochanical Addition HEAT SOURCE <br /> � PERMIT Combination U Piumb(ng IWORK R Altera0on I7 ElecMc <br /> i <br /> I IYPE Dem0lition U $ign 1YPE R New Gas <br /> Sprinkler LJ RcUaldMaint. B Olher <br /> I <br /> iCONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> IWORK CESCRIPTION <br /> � <br /> � PLUMBING MECHANICAL <br /> � NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � 1h'ATER CLOSET(TOILET) A/C–A/HANDLING UNITS <br /> � � BATHTUB FORCED AIR SYSTEMS <br /> ! � LAVATORY(WASH BASIN) HEAT PUMP <br /> I _� SHOWER UNITHEATERS <br /> � KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> = LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL � FIREPLACE INSERT <br /> GRINKING FOUNTAIN GAS FIREPLACE <br /> � FLOGR DrZAIN GAS RANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> SINK(ScRVICE/BARlMOP/ETC.) EXHAUST FAN <br /> i _ OTHER OTHER <br /> ��. � - - or.c– '� — <br /> � �_ flrc�v.0 �1W� <br /> I HERE9'I CERITIFI'THAT I HAVE REhD AND Ei(AIAINED THIS APPLICATION AND KNOW 7HE:AME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IhVJS nND ORIOINACcS GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> . �:O i. i HE GRnf�lTING OF h PER�d1T DOES NOT PRESUME TO GIVE FUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STi�Tc OR LOCAL Li�VI REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> �� O'l/NER OF THIS PROPERTY TO PERFORfd THE'NORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC70RS V! 18.27 RCW AND 295.200 VlAC. <br /> I� �e�� l�rl.ti s Sr- 7-� � <br /> Signature ol Owner/Contractor/Aut onzed Agent Date <br /> i <br /> DE31T & CREDIT CARDS ARE NOT ACCEPTED <br />