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NERMIT APPLICATiJN <br /> , CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-25?-E810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT!� <br /> -33oS Lc .,-,. � � � � X ooy3go79s-o - �3oc3 o- -�c2 <br /> LEGA LOT N0. BLOCK TRACT <br /> �E50. <br /> OWNER ADDRESS ZIP PHONE <br /> C�f,.,� �� 5 S � e �} ( ,� l, <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �I L K. lN� �`�L � L/Z.�S'O�l� ��l� <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> cn�ZS�-chf �:� �- �.c. l3 �x <br /> LL G �y / L )o�r <br /> PHONE 2 IaO– � �7Z 'd 3I � ZZb � ^j.Ne h. �/ �- . �� / �OVS7 E ( �'7SgI' <br /> 7 <br /> PpOPOSED USE OF BUILDING r1 Building � Mechanical Addition HEAT SOURCE <br /> PERMIT �� Combination Plumbing WORK Alteration ❑ Electric <br /> TYPE prDemolition Sign TYPE New �.] Gas <br /> LJ Sprinkler Repair/MainL U Other <br /> CONTRACT PRICE OF WORK /_ U,, �� Q�� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> �F,r <br /> WORK DESCRIPTION n <br /> I���xa �' �c�,.,cvn � o f- d �,'l��' `' f , <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM NO. TYPE OF FlXTURE OR ITEM <br /> �VATER CLOSET A/C–A/HANULING 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 _ 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/BAR/MOP/ETC.) EXHAUST FAN <br /> I = OTHER = OTHER <br /> i — <br /> i <br /> — — <br /> II HERtBY CERITIFY THAT I HAVE READ AND EXAMVJED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT. 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 VIOIATE OFl CANCEL THE PROVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGUV+TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> ' OWNER OF THIS PROPERTY TO PERFORM T E WORK FOR WHICH APPLICATION IS�dADE AND I COMPLY WITH THE STATE <br /> �I CONTRACTO�W 18.27 RCW 4ND 29 -WAC. <br /> � � ,-� y.., �-� 3 <br /> �, Sigr�'ature of OwnedContractor/Authonzed Agent Date � <br /> DEBIT & CREDIT CAROS ARE NOT ACCEPTEO <br /> . <br />