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PEr�MIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> � - I 4-D.� <br /> SITE ADDRESS i PARCEL TAX I.D.# PERMIT� <br /> � r� �' ( •'In���� � � i�' � l-'� Di:"�:;=? �/GC ���' ��✓c �6100 �-0\� <br /> LEGAL LOT NO. BLOCK TRACT . <br /> oesc. �„r 1? � 1 ' f� L�L� l,�C' ; � S � S `1 <br /> OWNER ADDRESS 21P PNONE <br /> —1 //L'IL�L,� ����1 ( �ii A l�wl �� LC/�'/L�11(,� �L�-� I �f��-:CS Ll'•�� .�J� ?���7 <br /> TENAN�AME — � CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ��r�r ADDRESS ZIP CONTR.LICENSE# <br /> � <br /> PHONE <br /> PROPOSED USE OF BUILDING � �Bui�ding I� Mechanical Addilion HEAT SOURCE <br /> PERMIT R COmbinali0n �-� Plumbing WORK R Alleration � Electnc <br /> • 7YPE D Demolilion Lj Sic�n TYPE D New Gas <br /> ��'.;, ;,,(, J ,,,,;,/. � ,� ;�.I: , U Sprinkler � RepaidWaint. 0lher <br /> CONTRACT PRICE�OF WORK CI1Y OF EVERE7T LOCAL SALES TAX CODE IS J105 <br /> WORK DESCRIPTION `- ' � ' <br /> i-u � 't l ;% , I �� ,:� �_ _ - <br /> PLUfABING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORI'(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPIACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(S[RVICE/BAR/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. A' L <br /> FROVISIONS OF LAWS AND ORIOINACES GOVERNING THIS.TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIfIEO HEREin�OR <br /> NOT. TF1E GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY JTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR�VHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRACTORS LAW 10.27 RCW AND 296.200 WAC. <br /> i <br /> /�- �- � <br /> ��- ly-- rc <br /> Signature ot wnedContractodAuthonzed Agent Date � <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED /�" <br />