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t <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR Sl REET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />-z'/ / <br />'QC, <br />SITE ADDRESS r-- PARCEL TAX I.D. # <br />PERMIT # <br />LEGAL LOT NO. BLOC <br />TRACT <br />DESC. <br />o ER ADDRESS ZIP PHONE <br />(425 - 35 3 4/�6-6G <br />A G7 <br />ATE NT NAME <br />CONTACT FOR P RMIT PHONE <br />,.,��dIG�,�4ar�sd <br />CONT CTOR ADDRESS ZIP CONTR. LICENSE # <br />2- /77T���/ys�7 <br />PHONE �as _�— 1(-�i -Ile Gc>'AAT 79 <br />PROPOSED USE OF BUILDING <br />PERMIT <br />li Building Mechanical <br />Combination Plumbing <br />WORK <br />Addition <br />D Alteration <br />I HEAT SOU CE <br />lectnc <br />Gas <br />TYPE <br />IILK_i(( Demolition Sign <br />TYPE <br />New <br />Sprinkler <br />Repair/Maint. <br />I Other <br />CONTRACT PRICE OF WORK <br />CITY OF EVERETT LOCAL SALES TAX CODF IS 3105 <br />WORK DE CRIPTION <br />/' <br />1/&L/4I Ili C/�'�U' /i��/ 1'('1A 1"e <br />i — <br />G'Yt O/D O/ �o it -tom P✓a�%Dl�i 71� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />__ <br />A/C—A/HANDLING UNITS <br />_ <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />_ <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />_ <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />_ <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />SINK (SEPVICE/BAR/MOP/ETC.) <br />_ <br />EXHAUST FAN / F% <br />_ <br />OTHER <br />OTHER h <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 GOVFRNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER 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 />GULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />STATE OR LOC=actor/A <br />OWNER OF THITHE <br />CONTRAC QR00 WAG. <br />— ct <br />/Date <br />Sign f 0 Agent <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />