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PE��MI'� APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAk 425-257-8857 <br /> I PARCEL TAX I.D.# ERMiT� � <br /> SITE ADDRESS ' � � �D/_ _/)� <br /> �� � V <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ^ ^ ADDRE55 ` 7 ZI PHONE <br /> VC���S ^ . { YI.�'rD"1� � .lJ . JfOk .�� (�(' G`le�� '' '�.L'w�"1 � ( OZO�o <br /> l <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> PHONE Q1+��1e� <br /> PROPOSED USE OF BUIL�ING I� Buildinc� f7 Mechanic:.' Addition HEAT SOURCE <br /> PERMIT K Combination H Plumbing WORK R Alteration � Electric <br /> IYPE �[ Demolition Ll Sign IYPE ❑ New Gas <br /> IJ Sprinkler �-� RepaidMaint. Other I <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 9t05 <br /> WORK DESCRIPTION ` � � � � � <br /> �, ;-a-n�:1 W� � rY:,��V'L cL� �\C C-C e.�..1�-' <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXNRE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C-A/FIANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HE:.TEP.� <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER IvIETAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN — GAS RANGE CE � <br /> FLOOR DRAIN _ <br /> BACKFLOW PREVENTER _ GAS PIPING I <br /> SINK(SERVICE/BAR/MOP/ETCJ _ EXHAUST FAN I <br /> _ OTHER _ OTHER i <br /> — � <br /> I � <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAh71NED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> i pROVI510N5 OF L4WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COh1PLIED WITH WHETHER SPECIFIED HEREIN OR �' <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESU6IE TO GNE AUTHORI iY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHeR II <br /> � STATE OR LOCAL• ECa TING CONSTRUCTION OR THE PERFORAtANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> �—O�NNER�OF THISP_ROPE ERFORM THE\VORK FOR�VHICH APPLiCATION IS MADE AND I COM11PLY WITH TFiE STATE I <br /> I CQ� CTORS LAW 3B:N ND 2°6.200 WAC. <br /> _��� <br /> i �-/S-v <br /> Signature o(OwnerlCon ctodAuthon e ent Date I <br /> I `J�'""�� �_ � & CREDIT CARDS ARE NOT ACCEPTED � <br />