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� <br /> � PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> � l� f7S UO� <br /> SITE ADDRESS PARCEL TAX I.D.# PER1117# <br /> a I l`I L�r�n 4�r.,��d }1ve;tit�e Ob� 3�1 I 4� �i u I ooD '93Q�Io�►-U' <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. 'D II N �D ��I/� <br /> OWNER ADDRESS ZIP PHONE <br /> triC � �ebra �Yy11t� ZII�I l.ui���u�d flve RBzop. <br /> TENANTNAMC CONTACTFORPERMIT PHONE <br /> 5 �1-ta I odcl 1,�JQI�e 3(.�0•--1`I�I- vl�Z � <br /> CONTRACTOF: ADORESS 21P CONTR.LICENSE# <br /> Wo IFe I�l�.�r�abin5 �E�C . 1�3� I -T��e Sf <br /> PHONE G�(2 ��� <br /> ?�o�= ��I- S�zl S� � =�� , YY�cnrue � <br /> PROPOSED USE OF BUILDING Building MeChdniCal Addilion HEAT SOURCE <br /> '�j „�I�(,n�e PERMIT � COrobineli0� � PlUrobi�g IWORK � Alte2tion � Eleciric <br /> ��C TYPE Demolition Sign TYPE New Gas <br /> Spnnklef Repair/Mainl. Other <br /> CONTRACT I�RICE OF WORK CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> WORK DESCRIPTION <br /> ���-���� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> I WATER CLOSET A/C—A/HANDLING UNITS <br /> � BATHTUB FORCED AIR SYSTEMS <br /> �(_ LAVATORY(WASH BASIN) HEAT PUMP <br /> �_ SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METALFIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOPIETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE �F WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES N0T PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERrORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM TFE WORK FOR WHICH APPLICATION IS MADE ANU I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> Signature of OwnedContrectodAuthorized Agenl Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />