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� <br /> pcRMIT APPLICATIt�N ! <br /> CITY OF EVERETT PERMIT SERVIC�S ��, <br /> 3200 CEDAR STREET, EVERETT, WA 98?G1 � <br /> 425-257-8810— FAX 425-257-8857 j <br /> i <br /> �ISITE ADDRESS PARCEL TAX I.D.# ERMiT» <br /> � � ! � . . ; :_ �, , . DO S(na5 L°�3 c'�03 O� � � ? <br /> I� I / ''J I <br /> LEGA LOTNO. BLOCK TRACT I <br /> DESC. I <br /> OWNER ADDRESS ZIP PHONE f s.,,�r <br /> ' -� � �� l � <br /> j' _" ._.:_ ._ _ � L/C /`C_ ' Cl�� �7 �Gf/ �1� !_. � ;�, <br /> TENANT NAME CONTACT FOR PERMIT � PHONE <br /> '� _. i <br /> > :. <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# � <br /> PHONE ���.,�� <br /> i <br /> PROPOSED USE OF BUILDING 1�Building n Mechanical Addition HEAT SOURCE <br /> PERMIT �i� Combinalion �_� Plumbing WORY, AltereGon Q ElecMc <br /> , � l/t" ;.-� 'i� TYpE �j Demolition LI Sign TYPE New �j Gas <br /> � ,_ U Sprinkler RepaidMaint. U Other <br /> CONTRACT PRICE OF WORK � '7 C2/.r7 CI7Y OF EVERETT LOCAL SALES TlUC CODE IS 3105 <br /> / O C <br /> WORK DESCRIPTION 'i <br /> U ��� � � �� <br /> ��<c(('l- l'� C� il <br /> ) <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FIXTURE OF ITEM N0. TVPE OF FI%TURE OR ITEM <br /> WATER CLOSET(TOILET) AIC-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 D�SPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEAT[R <br /> CLOTHES�VASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE � <br /> FLOOR DRAIN GAS RANGE � <br /> i BACKFLOW PREVENTER GAS PIPING I <br /> SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN , <br /> I OTHER • _ OTHER ; <br /> — _—_--_^i r.�19f.!�_ _ <br /> � <br /> �� I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS UF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED I:�ITH WHETHER SPECIFIED HEREIN OR ' <br /> ! NOT. THE GRANTING OF A PERh71T OOES NOT PRESUM1IE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL L,1W REGULATING CONSTRUCT�CN OR THE PERFORMANCE OF CONSTRUCTION. TNAT I AA4 AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK'rOR WHICH APPUCATION IS MADE AND I COMPLY WITH THE STATE <br /> � CONTRACTORS LAW 18.27 RCW ANO 296.200 WAC. <br /> � ��,/// ' .P�'ll�/ `�-�7-03 <br /> i Si r ture of O�`�wner/Con�tod uthonzed Agenl Date I� I <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED I <br />