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�- ,,. <br /> P�f�MIT APPLICATi01� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-SII57 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMi7# <br /> a 31 l.� �L3N �D AvE �D�o -o�i <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. � 3 <br /> OWNER ADDRESS ZIP PHONE <br /> �AIW /� N1 5��^LN l3 �� 1e �3�(tFlAur q8a�� �a�-as-a-sa� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> - S� � N '3f�Lw � a � � �tiGN ��-ald - ��04 <br /> CONTRACTOR ADORESS ZIP CONTR.LICENSE# <br /> PHONE I .� 1� p� I �/'1 <br /> �� n !J v <br /> PROPOSED USE OF BUILDING pERM1T I-� Sprinklealion R Plumbingal W�RK B RepaidMainL HEATSEIec�tnc <br /> 1YPE L� Demolition D Sign TYPE New � Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION �� <br /> �� r J <br /> PLUMBING MECHANICAL <br /> Nf). 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 R.4NGE 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/FiAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I — — <br /> i _ <br /> i <br /> � I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANU CORRECT. ALL <br /> ! PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> 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 PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHO^.IZED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br /> i CONTRACTORS LAW 18.27 RC AND 296.200 WAC. <br /> V�� ����� �����v � <br /> Signature of OwnedContracrodAuthorized Agent Date <br /> DEBIT & CR�DIT CARDS ARE NOT ACCEPTED � <br />