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j <br /> P�RMI`T APPLIC�4T1(.,N !, <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 li <br /> I <br /> SITE ADDRESS PARCEL TAX ;.D.# RPAIT ' <br /> � �T� �3? d 1 Q Z � ��' C,�UI <br /> LEGA LOT NO. 13LOCK TRACT �I <br /> DESC' � .�„ � <br /> OWNER ADDRcSS E+ �A ZIP PHON� ��� � <br /> � C �l Q,.�.�'�'�' !r <br /> ���1'� � c. Tc�o� 'P.��t ro83o u � p� �^v-��-- <br /> TENANT NAME CONTACT FOR PERMIT —� HONP E � <br /> I <br /> I <br /> CONTRACTOR ADDRESS ZIP CONTR.LICEtvSE# i <br /> /i� <br /> PHONE � `J �)�� <br /> PROPOSED USE OF BUILOING Q Building f"1 MeChaniCal Addilion HEAT SOURCE <br /> PERMIT �omhination �_� Plumbing WORK R Alteration � Electric <br /> � �� 7YPE Demolition IJ Siyn TYPE D New Gas <br /> prinkler U RepaidMaint Other <br /> CONTRACT PRICF OF WORK CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION <br /> 2e.-w�nv � �3��Z N �'D �o c� 7- �f o u S � , <br /> PLUMBING f17ECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTUflE OR ITEM I <br /> = bVATERCLOSET A/C—AIHANDLINGUNITS II <br /> � SATHTUB FORCED AIR SYSTEMS <br /> _ iAVATORY(WASH BASIN) HEAT PUMP <br /> .HOs/ER 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 I <br /> ORINKING FOUNTAIN _ GAS FIREPLACE I <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTEFl GAS PIPING �, <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN ', <br /> _ OTHER _ _ OTHER <br /> j — � <br /> I — — I <br /> � ' <br /> II HEREBY CERITIFI'THAT I HAVE READ AND EXHMINED THIS APPLICATION AN�KNOW THE SAME TO BE TRUE AND CORRECT. ALL �'', <br /> IPROVISIONS OF I.AWS AND ORi�INACES GOVERNING THIS NPE OF WORK'.YILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PER�d1T DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTAUCTIO�. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORt.1-�HE WORK FOR WHICH APPLICATION IS tdADE AND I COMPLY VJITH THE STATE � <br /> ��C ACTORS LAW 1817 RCW AND°96200 WAC. '� <br /> ���� 6 � �z- 03 �', <br /> Signatur Ow rl onlractor Au hor¢r:d Ag nt Date 1 � <br /> � � <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED , <br /> � <br />