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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.M P RMiT k <br /> / /� 'ie� •+ w� Fr.�i' `75'1�� - _ G -P�/i'� <br /> LEGA LOTIVO. BLOCK TRACT <br /> D[SC. <br /> OWNLR ADDRESS ZIP PHONE <br /> � ('�-�) <br /> ���nA `..� Do����-�e. "7RZ5 U�e� �.�e � c✓�r��•.wq$.To3 353 -9yH� <br /> TENANT NAME CONTACT NAM� PHONE <br /> �Irl¢al �ti%1 I/1pl t+ �iA �O G- .3.5�-1 - j�L3 7 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICEN5E N <br /> w�4 q8�3� <br /> PHONE J�� <br /> 3 3u S$ '`' ►- w �'°°9 <br /> PROPOSED U�E OF �UILDING Buiiding fl Mechanical Addition HEAT SOURCE <br /> PERMIT RI-{ CombinaHon H Plumbing WOFlK Alteration Eiectric <br /> , TYPE �j Demolition Ll Sign TYPE New R�-( Gas <br /> � (,�.�-� �``�-• �,�� U Sprinklef Repair/MainL U Other <br /> CONTRACT PPICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WOR�l'///R�cJ(_A/� `.Jl'r-(� `_ r "�YU l l.. ��n� .. �e'�. W�Yf"'� � /1�.�-� <br /> � / / � <br /> PLUMBING NAECHANICAL <br /> NO. TYPE OF FIICTURE OR ITEM NO. TYPE OF FIXTURE OR ffEM <br /> WATER CLOSET A/C-NHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> � = SHOWER = UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CI.OTHES DRYER <br /> DISHWASHER _ R�NGE HOOD <br /> IAUPJDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREP�ACE <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 /> PROVISInNS OF LAWS AND OFIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfH�R SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE 7F CONSTRUCTION. THAT I Ald AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK�JR WHICH APPLICATION IS MADE AND i COMPLY WITH THE STATE <br /> CONT �ORS W�.27 RCW AND 296.200 WAC. <br /> �E��yyl�J�l • d';- oy -03_ <br /> Signature of Owner/Contractor/Authorized Agent Date � <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED /� <br />