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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 2 3 � 425-257-8810- FAX 425-257-8857 <br /> ��� - ��. <br /> SITE ADDRE l PARCEL TAX I.D.# �,,�T� iTd�g PE� iT# <br /> �J/� �/ L�l�'1��Q.i CcS4So� z30i eo <br /> LEGA LOTNO. BLOCK TRACT <br /> DES0. � � r� �z3 �iNe �r2S�i 0,� .� <br /> OWNER ADDRESS ZIP PMONE <br /> (�4K���n� J�orr��s ���c... Ro .,3ox 8 y8 �K s���5 5�Zs8 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ' �?�� l�J �9�"`-C3 �.S �{�S 3 S� �-I Co"7 <br /> CONTRACTOR AUDRESS ZIP i:ONTR.LICENSE M <br /> PHONE L��'c L I{I pp i JL <br /> PROPOSED USE OF BUILDING Bullding � Mechanlcal Adaition HEAT SOURCE <br /> PERMIT ombination Plumbing WORK Alteradon R E�iecuic <br /> TYPE �emoli6on Sign TYPE New G�'Gas <br /> :5�=2 u Sprinkler Repair/Maint. U Other <br /> CONTRACT PRICE OF WORK C,� J�� CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> / n <br /> WOkK DESCRIPTION �.. O_ /y� <br /> / lJ -7/U - �Q� `�'�-�� F1' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM � <br /> 3 WATER CLOSET(TOILET) AIC-A/HANDLING UNITS <br /> 1� BATHTUB � FORCED AIRSYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br />', SHOWER UNIT HEATERS <br /> _J_ KITCHEN SINK 8 DI5POSAL 1 CLOTHES DRYER <br /> I DISHWASHER _L RANGE HOOD <br /> LAUNORY TRAY _L WATER HEATER <br /> _(_ CLOTHES WASHER _ AIETAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN �_ GAS FIREPLACE <br /> FLOOR DRAIN p--� GAS R,4NGE <br /> BACKFLOW PREVENTER tp GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) 3 EXHAUST FAN <br /> OTHER OTHER ' <br /> I HEREBY CERITiFY THAT 1 HAVE RE:1D FND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF WWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WNETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOWTE OR CANCEL TF1E PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUWTING CONSTRUCTION OR THE PERFORMANCE OF CONS�RUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM TNE WORK FOR WHICH APPLICATION IS MAD"c AND I COMPLY WITH TFiE STATE <br /> CONTRACTORS LAW 78.27 RCW P,ND 296200 WAC. <br /> �c1 � ! ; �Z/� <br /> iSignature of OwnerlCortracror/Authonzed Age ate <br /> �_ DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED , <br />