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f�RMIT APPLICATI�IN <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 � <br /> Po���- <br /> SITE ADDRESS PARCEL TAX I.D.N PEPMiT a <br /> d .���' IT J � <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC.� <br /> OWNER ADDRESS ZIP PHONE <br /> 1 � IC. D� � <br /> 'i !1%.cFc ., <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> � CONTRACTOH /'�1�,�.�� �r,i�� �1� �� fi� AODaESS �33I� S�. ySUlCl�j aP CONTR.LICENSEMq�y <br /> � PHONE � r �Tz3 �/i�-tJriQl��l'`�C <br /> \I� <br /> �G� �i35 SS55 <br /> � PROPOSED USE OF BUILDING Building � Mechanical Addition HEAT SOURCE <br /> ,� PERMIT B Comhinalion Plumbing WOHK � Alleration 17 Electric <br /> I TYPE D Demolition Sign TYPE New H Ges <br /> U Sprinkler Repuir/MainL LJ Other <br /> � CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> 1YORK DESCHIPTIO�J <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FO(TURE OR REM NO. TYP�OF FlXTURE OR fTEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> OISHWASHER RANGE HOOD <br /> IAUNDRY TRAY _ WATER HEATER <br /> � CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ ORINKING FOI�NTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERV�CE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> i HEREBY CERITIFY THAT I HAVE READ AND EXAf�tINED THIS APPLICATION AN�KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR <br /> t:OT. THE GRANTING OF A PERId1T DOES NOT PPESUtdE TO GIVE AUTHORIIY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAV!REGULATING CONSTRUCTION OR THE PERFORIdANCE OF CONSTRUCTION. THAT�AM AUTHORIZED BY THE <br /> 0'!!'7ER 0 HIS PFOPERTV TO PERFORIA THE WORK FOF WHICH APPLICATION IS MADE AND i COMPLY WITH THE STATE <br /> CO4TRA RS LAW 7827 R t 296.200 WAC. <br /> � <br /> llCw, � .s ✓ <br /> S�gnaWra of vmau ontractor/AuthonzeU Agent ate <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />