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PERMlT APPLIC�4TION j <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 I <br /> � <br /> SITE ADDRESS � PARCEL TAX I.D.# PERMIT# I <br /> ��n 6 G��,�6u� . �o y � sv 3��- ��, o�� ����,-�?g ' <br /> LEGAL LOT NO. BLOCK TRACT � <br /> DESC. I <br /> OWNER ADDRESS / ZIP PHONE I <br /> �I�1 n /"�q /l /S �� Go,�'b�rr� L/�S .1Sa- �`�(-�, I <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> 5� �� <br /> CONTRACTOR ADORESS ZIP CONTR.LICENSE# I <br /> PHONE � <br /> ( ����7('/1 � <br /> PROPOSED USE OF BUILDING Buildl�g � Mechanical Addilian HEAT SOURCE <br /> PERA7IT �Combination Plumbing WORK R Alleration � Elecinc <br /> TYPE Demolition Sign TYPE D New Gas <br /> � '/�.2�� � Sprinkler U RepaidMainl Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3'105 <br /> WORK DESCRIPTION ' <br /> ���� �,��c��e� 24 � X 2�-� <br /> , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A!C—A/HAND�ING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> i DISHWASHER RANGE HOOD <br /> � _ LAUNDRY TRAY WATER HEATER <br /> I CLOTHES WASHER METAL FIREPLACE/STOVE <br /> ' URiNAL FIREPLACE INSERT <br /> i _ DRINKING FOUNTAIN GAS FIREPLACE I <br /> _ FLOOR DRAIN _ GAS RANGE <br /> � � _ BACKFLOW PREVENTER _ GAS PIPING <br /> � �I _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST F�,N <br /> OTHER OTHER <br /> � I — I <br /> � — — � <br /> ; — —� I <br /> �� I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW TNE SAME TO 0E TRUE AND CORRECT. ALL I <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COAIPLIED l4'ITH WHETHER SPECIFIED HEREIN OR � <br /> ' NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITI'TO VIOLATE OR CANCcL THE PROVISION OF ANY OTHcR <br /> ISTATE OR LOCAL LAVJ REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM A�THORIZED 6Y THE I <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLI'WITH THE STATE I <br /> CONTRACTORS LAW 18.27 RCW AND 25"n.200 WAC. '� <br /> � �- I G- 03 I <br /> �,��11,�� n. }�C�. � <br /> �Signature of Owner/ConlractorlAuthor¢e�Agent Date � <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED '/y I <br /> � <br />