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PER11►'lIT APPLlCATION <br /> C�TY OF EVERETT PERMIT SERVICES „o <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � 0 '�'� 5 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERM�IT# ,l <br /> �+ ��1.` �>�= 6\i�.t'_61� i1'Il�l.l. WF7 �` J ' O /U( � <br /> LEGAL LOTNO. 6LOCK TRACT <br /> � DESC. <br /> IOWNER ADDRESS ZIP PHONE <br /> TENANTNAME CONTACTFOR PERMIT PHONE <br /> C�l�1ZNCS I JLu'iY Selt'�'e�'I �S3 - f-','7Z- `7ZZZ <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> AP_C "V�.-' Ci�-�`�•'Q,t:(it1.7.iJ iNL ��`» 5J .�2C.luT�.`�,— `7[x)iZ d+ecHC� �` z��1PiZ <br /> PHONE K� ' w �a <br /> PROPOSED USE OF BUILDING � Building � Mechanical n Addilion I HEAT SOURCE <br /> I PERMIT Combinali0n Plumbing WORK �u� Alteration R Electric <br /> TYPE D0rt101iti0� Sign TYPE Fj New u Gas <br /> Sprinkier LJ Repair/PdainL U Other <br /> CONTRACT PRICE OF WORK 3�� `7 U J�' CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> �i�i� � IZEI.c�luiU Si R1NKLe¢� �oZ N�+> �TI.�Ni�T <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTUHE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER C�OSET A/C-AIHANDLING 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 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/BARIMOPIETC.) _ EXHAUST FAN <br /> — U7,yFR OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAh1E TO BG TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING'HIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIfIED HERE!N OR <br /> NOT. THE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHORIN TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE VJORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> i CONT�i6TQRS LAW 1827 6MTlCf�D 296. U WAC. <br /> � ��-� J <br /> IlJ a. u� <br /> Signat of Ow dContrac or Author¢ed Agent Da e <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED i <br />