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�ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADORESS PARCEL TAX I.D.# PERMIT a <br /> ,�, � -r ,, � , � . oo � oc� Do � -o� <br /> �EGA LOT NO. BLOCK ACT � <br /> DESC. � � / — . /� . <br /> . OWNER AODRE55 Z�P PH� <br /> � H s- 3v�-isa� <br /> ��IHFr� .c�, ' 4 � �. w. c'i . <br /> i TENANTNAME CONTACTFORPERMIT PHONE <br /> LONTRACTOR ADDRESS ZIP CONTR.LICENSE A <br /> �� PHONES/'�/'"I fc' , <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> PERMIT R{._( �C mbinalion R{-( Plumbing WORK Alteration R Eleclric <br /> j 1YpE �.),j'Demo�ition U Sign TYPE New �,j Gas <br /> I ' LJ Sprinkler Repair/MainL U Other <br /> I� CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SAIES TAX CODE IS 7105 <br /> I WORK DESCRIPTION <br /> ,, �L�'MO ' .�j 'YC.LrZ `'L�/�7 . 4- �jR/�/iU� . <br /> / <br /> i PLUMBING MECHANICAL <br /> I N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATEP.CLOSET(TOILET) _ A/C-PJHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> , LAVATORY(WASH BAS�N) HEAT PUMP <br /> ; SHOWER _ UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRY[R <br /> DISHWASHER RANGE HOOD <br /> � LAUNDRY TRAY WATER HEATER <br /> , CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPIACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> i HEREBY CERITIFY THAT I HAVE READ AND EXA�dINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVIS�ONS OF LA`!JS AND ORIDiNACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GFANTING OF F PERMIT�OES NOT PRESU6IE TO GIVE AUTHORITY TO VIOLATE OP.CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL'..f�W REGULATI STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER HIS PROPERTY T ERFORP. E WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONT CT RS LA1j� 78.27 R AND 296 VJA <br /> �� / _ _ U <br /> � ' �. , .' � <br /> Sign9t(rre of Owner/ ntraCrodAuth nzed nt ete ��3p <br /> I '-�0 7 <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />