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i- --- -- <br /> P�r�N11T �►PPLI�ATIO��1 <br /> �I CITY OF EVERETT PERMIT SEkVICES <br /> i 320L' CEDAR STREET, EVERETT, 1,NA 98201 <br /> i 425-257-8810— FA,`C 425-257-8857 � <br /> � �n --�'f <br /> SITE ADURESS PARCEL TAX I.D.# P�RMiT� <br /> c�<<,_, t� - . iu �r�. EJt� �o�a �o�� �o� s� � �'��� -�os <br /> LEGAL LOT NO. J BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS � ZIP PHONE ��� <br /> ` � � C� � � b - � <br /> � C � -� I �t-�-t', rc �c ) c � , -�G , <br /> �f=}k'li'lj A ��� !��' ,rlt� �?���x'�f �' Cc,>7� ��., ,, �T� � ,; .,.i �/���-���n �'��G _ � <br /> TENANT NAME `� CONTACT FOR PERId1T PHONE <br /> .]—.�, <br /> i <br /> � � �� ` � <br /> � �7(:`7("l' ��� f I l��' �K�� `�- <br /> CONTRACTOR� ����� �� ADDRESS ZIP CONTR. LICENSE# ' <br /> PHONE <br /> i <br /> i PROPOSED USE OF BUILDINd Building Mechanical ACdition HEAT SOURCE <br /> I <br /> I _ ____ �ERMIT Combinalion RI--( Plumbina WORK Alteration Electric i <br /> �� j � � / 7vaE � Demolition U Sign TYPe New � Gas <br /> t 4t \6� � .�j (�(���1� Sprinkler RepairlA7alnL Other �I <br /> i Cf�NTRACT PRICE OF WORK ,i�Q��J -- CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 i <br /> WORK OESCRIPTION I <br /> -, � � �� � / . <br /> �����.; i �, << � ;� � �, ��.�- �_���� 1�� �,t�, ;,� �,-r, �I <br /> � � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N(?. NPE 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 _ UNITHEATERS <br /> , KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HCOD <br /> LAUNDRYTRAY _ WATERHEATER . <br /> CLOTHES WASHFR _ METAL FIREPLACE/STOVE 'i <br /> �'� � URINAL _ FIREPLACE INSERT I <br /> I I _ DRINKhVG FOUNTAIN _ GAS FIREPLACE � <br /> FLOOR DRAIN GAS RANGE <br /> . BACKFLOW PREVEi�TER GAS PIPING i '�, <br /> SINK(SERVICE/BAR/MOP/ETC.) �� EXHAUST FAN <br /> i _ OTHER = OTHER I <br /> II I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICAT�ON A�D KNOW THE SAME TO BE TRUE AND CORRECT. ALL I <br /> I PROVISIONS OF L4WS AND ORIDINACES GOVERNING TNIS TYPE OF WORK LVILL BE COfdPLIED 4VITH WHETHcR SPECIFIED HEREIN OR <br /> INOT. THE 3RANTING OF A PERMIT�OES NGT PRESUAtE TO GIVE AUTHORITI'TO VIOLATE OR CANCEL THE PROVISIUN OF ANY OTHER i <br /> � STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE I <br /> �' OWNER OFTHIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MACE AND I COMPLY WITH THE STATE <br /> I CONTRACTORS LAW 18.?7 RCWyAND 296200 WAC. <br /> � ��� V �' � ` - i�.. � �� '� (c �.?'.�., �/ I <br /> �r L �� l . ��;�i � , ,�:-,,�- <br /> Sign2lur� e o�ef/ContractotiAutNonzea�yent — Date -- — ^ <br /> !i 1 <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED ��I <br /> < <br />