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�- ERMIT APPLICATiJN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA y8201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAJ(I.D.N PERMIT x <br /> � l 3/ �o%��br� /�v� co3a3 -d l S <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER AUDRESS ZIP PHONE <br /> �3� � Antiel <br /> zl3l Col�mb,a Ace 9Bz�3 yZs� GBI-9��3 <br /> TENANTNAME � I CONTACTNAME PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.IJCENSEN <br /> PHONE <br /> PROPOSED USE OF BUILD�NG Building I� MeChanlCal Addition XEAT SOURCE <br /> PERMI7 � Combination H Plumbing WOHK R hlterelion � E��Ie tnc <br /> TYPE Demolition �� Sign '�YPE D New <br /> Sprinkler � RepairlMaint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVEREST LOCAL SALES TAX CODE IS 3105 <br /> WORKOESCRIPTIONC09 ��� iT 7br �n,�t�e finc�' Ta ct Cara�e . /'��T T�c �a.aye cr� hAck �, . <br /> PLUMBIPlG MECHANICAL <br /> NO. TYPE OF FIXTURE OR�7'EM N0. TYPE OF fl%TURE OR ITEM <br /> WATER CLOSET _ A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 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(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND F�CAMINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETH[R SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROV�SION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PPOPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 2 200 WAC. <br /> -, �.��, �� y�3 <br /> Signat�OwnedCon r�q /Au onzed Agent Date <br /> �/ <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />