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� <br /> �ERMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERM�T# <br /> ��� L- ����/ 9�� oo`i� o00 0� [�3J0 OD' <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> pR�u�Nq � ��� UaR��v /o�scRowN � R. 98�3 yzs2sz-�ev-� <br /> TENANTNAME CONTACTFORPERMIT PNONE <br /> D+��� 4�,�H 5�, �l2 S-2 s9'-2.9 so <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> pNu�f�anso,vC�S�ow� ew�fs'�nti , �o sy .t/,PAex oR 9J32o3 pr�v€tiGFfo'1 Zx4 <br /> PHONE <br /> PROPOSED USE OF BUILDING Building � MeChan(Cal Addition HEAT SOURCE <br /> PERMIT B Combination Plumbing WORK R Alteratlon I7 Electric <br /> TYPE D Demolilion Sign TvpE D New � Gas <br /> U Sprinkler U RepaidMaint. Other <br /> CONTRACT PRICE OF WORK ��i; � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> (ii.�/ <br /> WORK DESCRIPTION • <br /> ��( c.�o,� C ►ARPoar � ��uov+�T� T�X�STrN� C��4TN <br /> PLUMBING 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 /> � LAVATORY(WASH BASIN) HEAT PUMP <br /> �g SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> 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/BAWMOP/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 PRESUAtE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THc PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATI G CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> O OP THIS PROPERTY T ERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> C �ACTORS�+W 1¢.27 AND 29fi200 WAC. <br /> �j"[.V W�� ��l D"_F�� <br /> Signature o(OwnedContractodAuthonzed Agent Date i � <br /> DEBIT& CREDIT CARDS ARE NC�T ACCEPTED <br />