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; <br /> ( <br /> ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 �U J �I I J �, f � <br /> � �-� � <br /> SITE ADDRF, S PARCEL TAX I.D.# PERMIT# <br /> ��� �� �os 9 �a) C�' 3� I- o <br /> LEGA LOTNO. BLOC�Kj T1jA�T�T O� J " � �Oy <br /> DESC. �' I� � � ( I�� [.t> Sl.�l�ll <br /> OWNER e5 � � �pv��- AODRESS UG ZIP PHONE �aa' j' <br /> � ,�r� lC� G+�A- '1�vZ0� <br /> TENAN7 NAME C TAC OR PERMIT PHONE <br /> �".� ��c ���� yaa-as 3� <br /> CONTRACTOR ��`�,� ADDRESS ZIP CONTR.LICENSE AI <br /> PHONE <br /> PROPOSED USE OF BUILDING f� Building fl MechaniCal fl AddiUon HEAT SOURCE <br /> PERMIT W� Combination H Plumbing WORK �r� Alterauon D Electric <br /> TYPE G...( Demolition Ll Sign TYPE Jd( New Q�� Gas <br /> L] Sprinkler U Repair/MainL U Olher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK OESCRIPTION �%I ,Uew O v��PA <br /> / <br /> /5� r��e a 73 �ae�r� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR�TEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB o� FORCED AIR SYSTEMS <br /> LAVATORY(WA�H BASIN) _ HEAT PUMP <br /> SHOWEP, UNIT HEATERS <br /> � KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY 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(SERVICEIBAR/MOPIETC.) � EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CcRITIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PROVISION OF Af`IY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORti1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF 7HIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> 0� <br /> Signamre of OwnedContr rlAuthonzed Agent Date �I <br /> v <br /> �EBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />