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� ^' r <br /> PEr�MiT APPLICATIOrJ <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> I��I � �o-Dp7 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � 21 f�P� « .�J o 0 <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> y�s- �0 5 �9s <br /> �i��,��c./ ��.-� ��r � p /!�nl /�y rti ��v S � � Uoy <br /> TENANT ME CONTACTFORPERMIT PHONE <br /> � � �T�� u� 1 ��� � �s� a.s-s��z� <br /> CONTRACTOR P�uvr bl h!n �hrJf�SS.����ODRESS ��3 �GGaCrLt ZIP�7' q CONTR.LICENS7F�#7 `7� � <br /> J y 9tS.�J/� P,t.�l'Y1�T�-YrJpleUJ <br /> PHONE a` CJ('3 c?S S I d Z� SU o'�2 �-�ll`� <br /> PROPOSED USE OF BUIL�ING Building I-1 Mechanical Addition HEAT SOURCE <br /> PERMIT Combination K�, Plumbing WORK Alteralion Q ElecMc <br /> IYPE Demolition LJ Sign TYPE New �j Gas <br /> Sprinkler RepaidMaint. U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 9'105 <br /> WORK DESCRIPTION �N7�n� ' � To i i � T'� J Lc� v <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 1_ WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _L LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER 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/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> � - I <br /> 'I I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS HPPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL I <br /> .� PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF INORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR i <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER i <br /> I STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PER ORM T 4VORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE I <br /> CONTRACTORS�AW 18. 7 RC}N'A 296. WAC. <br /> � // � <br /> � � <br /> i i <br /> iign e of Own r/ oniractodAutho d Agent Date i <br /> ' � DEBIT & CREDIT CARDS ARE NOT ACCEPTED I <br />