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�ERMIT APPLICAT`1JN <br /> 1 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> PARCEL TAX I.D.# PERMIT M <br /> SI,T E ADDRESS L' d3�3'Q� �J <br /> b �lI t^� L.Zi`�T'r � Lo-r 1� <br /> LEGA LOTNO. BL K TRACT SS � ��� ��949 <br /> DESC. �� �� ���2" �� pp pHONE <br /> OWNER ADORESS /�/��,j�J9�s � <br /> 'i �- ,•U . O . 4 L����� PHONE � <br /> TENANT NAME I CONTACT NAME 41�0 .2&�� <br /> � — 1 J5 <br /> CONTHACTOR <br /> ADDRESS LP ONTR.LICENSE M <br /> PHONE S n - � <br /> 67''yl� <br /> Building Mechanical Addition HEATSOURCE <br /> PROPOSED USE OF BUILDING [� � Electric <br /> PERMIT � Combination U Plurnbing WORK Alteration Gas <br /> TypE Demolilion U 5�9� TMPE New <br /> S rZ Sprinkler Repair/Melnt. Other <br /> / �..._ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> CONTRACT PRICE OF WORK � �/�� <br /> WORK DESCRIPT70N <br /> CONS�uG� ,v�tcJ l,jl� {� s � ' <br /> PLUhIBING MECHANICAL <br /> NO. TYPE OF Fl%TURE OR REM <br /> NO. TYPE OF flXTURE OR ITEM <br /> � WATER CLOSET A/C-A/HANDLING UNITS � ��� <br /> f FORCED AIR SYSTEMS—6� � <br /> BATHTUB HEA7 PUMP <br /> LAVATORY(WASH BASIN) UNIT HEATERS <br /> SHOWER _L CLOTHES DRYER <br /> 1 KITCHEN SINK&DISPOSAL � qANGE HOOD <br /> � DISHWASHER WATER HEATER <br /> LAUNDRY TRAY METAL FIREPLACE/STOVE <br /> 1 CL01 HES WASHER FIREPLACE INSERT <br /> _ URINAL .� GAS FIREPLACE <br /> DRINKING FOUNTAIN GAS RANGE <br /> FLOOR DRAIN � GAS PIPING <br /> BACKFLOW PREVENTER EXHAUSTFAN <br /> SINK(SERVICE/BAR/MOP/ETC.) pTHER <br /> OTHER — <br /> I HEPEBY CERITIFY THAT I HAVE FEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> iPROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WCRK WILL BE COMPLIED WITH WHETh:ER SPECIFIED HEREIN OR <br /> �. STOATE OR LOCALILAW REGULATING C�ONS RUCT OSN OR TOHE P RFORMANCE OF COP STRU IOPNCTHAT AM lOUTHIORIZED BY HE ER <br /> � OVJFJER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS 1�1ADE AND I COMPLY WITH THE STATE <br /> ��RACTOFS LAW 7 8.27 RCW AND 296.200 WAC. <br /> � IL. Ae � C�� � � � '����� <br /> �, ignalure of Ovrner/ ontrecloi/Authonzed Agent �a1e (/L <br /> j DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />