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PtRMIT APPLICATI�IN <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.# PERMIT# <br /> � . � c E i'�OD� L.r� M o3o7-oIS <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER AUDRESS 21P PHONE <br /> Ff,�r//u,P T �" �9c,�c,� <br /> �s�9f E I C����RPERMIT ��S"�y8��i9 <br /> .� <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE A <br /> PHONE <br /> PROPOSED USE OF BUILDING fl Building � Mechanical Additlon HEAT SOURCE <br /> PERMIT K Combination Plumbing WORK Alteretlon R Electric <br /> TYPE �__� Demolilion Sign TYPE New �._j Gas <br /> U Sp�inklef RepaidMaint. U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> WORKDESCRIPTION ��—�JLAe�- �f/f j�/L �'f�� %G2 � C�«�2 //z�v�OG{,� <br /> i.�'s��«�1 r.u.� o F' �..gs FiaE nL�cE �,vs T����- T�.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ AIC—AIHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWcR _ UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER ���L�C��C'J�- <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 HERE9Y CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRU-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 PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TME <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br /> �-��a-��o-c� 7r.�/o3 <br /> Signature of Owner/ContractodAuthorized Agent Date <br /> DEBIT& CREQIT CARDS ARE NOT ACCEPTED <br />