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�, �, _ <br /> P�RMIT APPLICATIO�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> , 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8870 — FAX 425-257-8857 <br /> SITE ADDRESS P RCEL TAX I.D.# PERMIT tt <br /> � 1 3 DIOC�d mo�tc��_ <br /> LEGAL LOT NO. BLOCK , TRACT <br /> DESC. � � �,v <br /> OWNER A�DRESS ZIP PHONE <br /> �-�. �����.� �i� 9 �����1 .,,� �,�a� i��1 <br /> TENANTNAME CONTACTFORPERMIT PHONE �— <br /> � C'�t:��-n�i1 ��� �.,P ��5��-�� <br /> CONTRACTOR � M A�p���� ADDRESS ZIP CONTR.LICENSE# <br /> // ( / T- <br /> PHONE . /�� �....J ` I r ICJ([7�1C/�J ��/I� .,U C ' <br /> I�! <br /> PROPOSED USE OF BUILDING Building I� MeChaniGal f'1 Adtlition HEAT SOURCE <br /> PERMIT Combinalion �_� Plumbing W K IIr2�4 Alteration Electric <br /> TYPE Demolition L� Sign TYPE �j New �Gas <br /> Sprinkler U Repair/Maint. _ Other <br /> CONTRACT PRICE OF WORK ^� CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> �: � W <br /> WORK DESCRIPTION <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPF OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C—A/HANDL�NG 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 /> _ LAUNDRYTRAY � WA�ER HEATER <br /> CLOTHES WASHER METAL FIREPLACElSTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> � FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXNAUST FAN <br /> OTHER OTHER <br /> � I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS AP?LICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS.TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> iNOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTIO�OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUI�HORIZED BY THE <br /> � 'NER OF THIS PROPERTY TO PERFORM THE WORK FOR IVHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> I .JTRAGTORS LAW 1827 RCW AN 296.200 WAC. <br /> /l�!��//[.E�--l-//_///�l �� / (J� <br /> I Signature of OwneNContractod9luthonz�dAgent Dat <br /> DEE31T & CREDIT CARDS ARE NOT ACCEPTED <br />