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PEt�!`Jll� APPLICATION '' <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-8810 - FAX 425-257-8857 I <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT» <br /> (� :- �i- d -D�� <br /> iC'(i'� y_ r;n,lin.r.'� 'lo� _�•cIC � <br /> LEGALI LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> r r <br /> rwyzs-337-89`1a <br /> .. �� .� ,�.i � ,�.�j�'- ✓� � F ��ol�ni;i5�. �i�}.;'�. c.el� Zo���l>9'(y��3 <br /> TENANT NAME CONTACT FOR PERMIT PHONF <br /> CONTRACTOR ADDRE55 ZIP CONTR. LICENSE# <br /> PHONE <br /> PROPOSED USE OF BUILDING 8uilding I-"1 Mechanical Addition HEAT SOURCE <br /> PERMIT R Combination �_� Plumbing WORK B Alteration � Eleclnc <br /> TYPE Demolition LJ Sign 1YP[ I ) New Gas <br /> B $prinkler Q Repair/Maint. Other I <br /> CONTRACT PRICE OF WORK i 1/'�/' - CITY OF EVERETT LOCAL SALES TAX COOE IS 3�05 � <br /> / / � f � <br /> WORKDESCRIPTION ,_,��{_t� •.p, <br /> W . r,c'✓lo� c .�c...tii r n, <br /> -/r u �..:-. .. ^- - _.` • , <br /> /\'U.i ...�.0 ,_ ,•.i^.� r "'r� � _ r, Jn-� v.� �jc. cn'vc.JC bG9fLocM .�1 ,._.J . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METf\L FIREPLACE/STOVE <br /> URINAL FIREi�lACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETCJ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> � — — <br /> i <br /> � <br /> � <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL .� <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> I NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORAtANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THe � <br /> iOWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WNICH APPLICATION IS MADE AND I COMPLY WITH THE STATE � <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. I <br /> � ' -��-o � I <br /> Signature of OwnedContracrodAulhorized Agent � Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED i/z <br />