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P�RMIT APPL�CATI(�N <br /> CITY OF EVERETT PERMIT SERVIGES � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810- FAX 425-257-8857 � <br /> //��7`�� <br /> SrITE ADDRES/S PARCEL TAX I.D.# PERMiT M <br /> U S�/ (. j,Oj (,(- S 7� h1Glo 1 ` <br /> LEGA LOTNp, BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> /�/(h�ir��� ,Sf ��r��� � Z `/L-- �'r,r�J`�` �t•-t�jzl y�fz�3 �fz5-3s�-3n ; <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> � �, �� �C.!/f,� / �fz �- 23�3-/ 7Z 6" <br /> CONTRACTOR , ADDRESS ZIP CONTR.LICENSE# <br /> ,F��l.il �/r,-� �7�t �� �� J�rv��' -Y» c �I7 z ���Z�� / �L��it�S,SGI�Z/f"� <br /> PHONE �L 0/ �vt��-Q� . "• <br /> �Zs - 25 `i- Z /l• / � <br /> PROPOSED USE OF BUILOING I"") Building Mechanical [� AtldiGon HEAT SOURCE <br /> ,, PERMIT ��� Comtination � Pl9mbing WORK �)9 Alteration � Electnc i <br /> I--( <br /> TYpE �j Demolilion U Si n TYPE D New Gas <br /> � f'S u Sprinkler U RepaidMainL Other I <br /> CONTRACT PRICE OF WORK L,7�C, �c�� CITY OF EVERETT LOCAL SALES TAX CODE IS J105 II <br /> rT <br /> WORKDESCRIPTION��r� yr'� �C ��*�'��SK' 'f �°r< �GG�'' <br /> •`� <br /> PLUMBING MECHANICAL <br /> NO. TY°E OF FIXTURE OR ITEM N0. . TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS I <br /> BATHTUB � FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP � <br /> SHOWER _ UNIT HEATERS i <br /> KITCHEN SINK 8 DISPOSAL __ CLOTHES ORYER I <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/MOPlETC.) _ EXHAUST FAN I <br /> OTHER OTHER I <br /> � I <br /> I I <br /> � I HEREBV CERITIFY 7HAT I HAVE READ AND EXA611NED THIS APPUCATION AND KNOW THE SAAtE TO BE TRUE AND CORRECT. ALL <br /> � PROVISIONS OF WWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COAIPLIED WITH 11'HETHeR SPECIFIED HEREIN OR �. <br /> NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISIO�OF ANY OTHER i <br /> i STATE OR LOCAL LAW REGULA7ING CONSTRUCTION OR THE PERFORMANCE Or CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK rOR V'VHICH APPLICATIO�IS M1tADE AND I COAtPLY WITH THE STATE i <br /> I CONTR�CT�&LAW �8.27 R W AND 296.200 WAC. � <br /> ' �;1 /ll<��' //Z7- c� E <br /> Signature of OwnenContractor/Authonzed Agent Date <br /> I DEBIT & CREDIT CARDS ARE NOT ACCEPTED ' <br />