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� . <br /> — — ---- �--- � -- <br /> � PERMfT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> li 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> i 425-257-�810— FAX 425-25i-F3Fl57 <br /> � I <br /> �i FITE ADDRF.SS � PARCEL TAX I.D.H �'F'�•'�•��T- '. <br /> :3 •2 � r.e u �: �''ru , � G o c_w`f_ i <br /> I iPGnt LOT NO. BLOCK TRACT <br /> � nesc. ! <br /> OWNER ADDRESS ZIP PHONE - <br /> i �1 / <br /> � Na� �1 ac�_1 c�o�� d�3� �-����c��rl ;-i�1�� �v=r;-�- 4��oi ( °�(as�d5�-�1�� <br /> � TENANT NAME I CONTACT OR PERMIT PHO 1 <br /> I ( <br /> � CONTRACTOR J �y � AOORESS�/ /�j�7 21P CONTR.UCENSEa <br /> I PNONE �I�I�IIiC�� Qf k���l�Cl��. � .1�11�0�\ J��il'Q, W!f I��/lJ �lt�.lUlPlLcf�3�I�(nl <br /> C3� � ��-:�� 6� , �/�.���U> Y � <br /> I PROPOSEU USE OF BUILDING I DUild ng �p{R1eChanicnl �ddilion HEAT SOURCE <br /> � PERMIT Combmalion �_� Plumbmn WORK Mtei�lion [� Eioclnc <br /> ' TYPE �Denloli�ion Ll Siyn TYPE ��New �,.j �.�: <br /> iSprinkler U Repmel.uwii. �.� Otiwr <br /> '� CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%LOOE IS 3105 � <br /> I <br /> I WORK DESCRIPTION I <br /> 7Z ��P�� ' <br /> � I <br /> PLUMBING MECHANICAL � <br /> � <br /> I NO. TYPE OF FI%TURE OR IiEM NO. TYPE OF FIXTURE OR ITEM <br /> '� _ WATER CLOSET AIC NHAN�LiNG UNITS I <br /> i = BATHTUB _ FORCED NR SYSTEA9S � <br /> LAVATORY(WASH BASIN) HEAT PUA"P <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL CLOTHC-S ORY[R '� <br /> . DISHWASH[R RANG[HOOD <br /> �'. LAUNDRY TRAY WATER HEATER <br /> i CLOTHFS WASHER METAL FIREPLACE/STOVE <br /> ' URINAL FlR[PLACE INSERT <br /> � _ DRINKING FOUNTAIN _ GAS FIREPLAC[ I <br /> � _ FLOOR DRAIN _ GAS RANGE � <br /> BACKFLOW PREVENTER GAS PIPING � <br /> I _ OTFIE,RERVICE/BARlMOP/ETC.) � OTHERA{s�N C IZY���`����� I <br /> , _ _ _ ������ ; <br /> I <br /> i - - . I <br /> � I rIERE�V CERIiIFY THAT I HAVE READ AND EXAh11NE�ih115 APPLICATION AND HNOW THE SAhfE TO DE iRUE AND CORRECT ALl <br /> IPROVISIONS OF LAWS ANO ORIOINACES GUVCRNING Th115 TYP[OF WORK WILL UE COAIPLIED WITH WHETH[R SPECIFlCD HEREIN OR <br /> IJOT. THE GR�NTING OF A f'ERMIT DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROV�SION OF ANY OTHER <br /> �'�TATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFOR�fANCE OF CONSTRUCTION THAT I AAI AUTHORIZE�8V THE I <br /> i oSYNER OF iH15 PROPERTV TO PERFORAI iHF WORN FOR WHICH APPLICATION IS I.1nI1F n�U�I Cnfdl9 Y C:If�� THF tiL�'F � <br /> iCJNTRACTORS LAW 7827 RCW AND 296 200 �C. I <br /> � �7 ��-.ti.-. �. '�'— ��� �i <br /> �� SignaNra ol OwnerlConVaclodAulhonzed AgeN ' ate �/� <br /> i � <br /> DEBtT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> I .. . . ___ . ___ _._ . . . _ . _. __ _._ —"—___ 'J <br />