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� PERMIT APPLICA'� ION <br /> I CITY OF EV�RETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> � _ 3 0 � D/ �I <br /> SITE ADDRESS PARCEL TAX I.D.# � P AIT# <br /> i <br /> )�1 � /� �c /� "(,L ' ��' �L � <br /> LEGA LOT NO. BLOCIC TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �m�� ��r�� ����6- �?� � <br /> CONTRACTOR ^ ADDRESS ZIP CONTR.LICENSE# <br /> lJ����T F Luv�61XJ G- r?����7 Sts '=��� 1'�C�f���' q�sc�� �,�f�f "c �r t�k�� <br /> PHONE � <br /> =�-r7S - �' �(- -'" n <br /> PROPOSED USE OF BUILDING Buildlflc� Mechanical Addition HEAT SOURCE <br /> I PERMIT R Combinelion �nPlumbinc� WORK R Alteralian � Elec7ic <br /> TYPE Demolilion �Sign 7'!PE New Gas <br /> B Sprinkler � RepairiMaint Other <br /> CONTRACT PRICE OF WORK -�' 7��_�-� G� CI'fY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> �i L>1� �'{�-ti.sv� ��> i c�� <br /> i <br /> PLUMBING MECHANICAL �I <br /> NO. TYPE OF FIXTURE OR ITEM NO. 1YPE OF FIXT�JRE OR ITEM ' <br /> _ WATER CLOSET(TOILET) A/C—A/HANDLING UNITS � <br /> DATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 9F6i�6&AL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> �� , _ URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/3AR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE S.A�dE TO BE TRUE AND CORRECT. ALL <br /> �. PROVISIONS OF LAWS AND O4IDINACES GOVERNING THIS TYPE OF WORK�h'ILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A F cRMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> . STATE OR LOCAL LAW REGULqTING CONSTRUC710N OR THE PERFORMAMCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OFANISP aPERTY TO PERFORAI THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRkG`T�/R 5 F� 8 2i RCW AND 29fi.200 WAC. <br /> � //" � `' � � �� i� <br /> Si �of(ANneNContractodAulhonzed Agen[ Date <br /> /� <br /> DEBIT & CREDIT CARDS ARE NOT RCCEPTED <br />