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PERMIT APPLICA ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> P� 3��- e�� <br /> SITE AD ESS � PARCEL TAX I.D.# P MIT u <br /> , S �u-P� GD59 7 6I oa �o //-D � <br /> LEGA LOTNCO. / BLOC�K7 R^AC�T �J���J <br /> DESC. � ` I (O S / �/T* Q� SLCJI�S�fJPI� /JY�C�[/f7G <br /> OWNE or� ADDRESS ZIP PHONE <br /> �T �eG 3aa� /a/5'�P/ sE q�ao� v�s yaxa�33 <br /> F�,�refi- tu.Q <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> CONTRACTOR ��+ �' e ��y}5�'ADDRESS,�� Ia y�7 21P CONTR.LICENSE N <br /> 9ve �'F Eve�cff- wA� �t�� <br /> PHONE v�s yaa -as3 s <br /> PDRO�POSED U/S�E O� F BUILDING pERMIT {'� Sp�fIkll8afi0� R Plumbing al WORK � Repa dMaint. HEAi SE Q��E <br /> (.�S 1�Y7��PX 7ypE U Demoiition � Sign TYPE New �O`�sef <br /> � 'U <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION �}v��� �C!(J UpIP1� <br /> ., �• <br /> /S7 �' �� � ,,2 73 �,�e�e <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. . TYPE OF FD(TURE OR ITEM <br /> WATER CLOS[T(TOILET) A/C—A/HANDLING UNITS <br /> � BATHTUB 'o� FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> 'o� KITCHEN SINK& DISPOSAL il— CLOTHES DRYER <br /> oC 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/8AR/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 /> 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 AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOR W 18.27 RCW AND 296.200 WAC. <br /> 1��� <br /> Signature of Own ontractor/Authonzed Agent Date <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED /L <br />