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P RI1lIIT APPLICAT O <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982C <br /> 425-257-8810— FAX 425-257-8857 <br /> SIT ADDRES� /� � PARCEL TAX I.D.# /' f/RERMI7# <br /> � � .J�{�I/iLtA.'i � `O Q4� V O(/ f� ��' CXJ/ <br /> LEGAL LOTONO. � BLOCK TRACT ��� <br /> DESC. <br /> _� �ER G�� Od C . ADD� �j�N �r ZIP � PHON��� <br /> p�11�K1 D 1 �11� 4 �,r ��c.� a� Ln. 9�,?� So3 �G �� <br /> TENANT DIAME � I CONTACT FOR PER IT ��n PHONE�� ��( <br /> �� G � 7` a s � 3 <br /> CONTRACTOR ��� ���� �d�i"nA_/�� Z�p ���� N f,� <br /> aH1 ah � c w •ti i G <br /> PHONE5�3. 3�5' DG� 3 / Q�/ ��. 4r ( 7 � �$� �.� <br /> 0� Q5�USE OF BUILDING pERMiT � Sprinkileation � Pl9mb ng�l WORK b( Repaair/1AaiN. HEAT SEIURCc <br /> /. �1- <br /> '� TYPE Demolition Si n 7YpE U�� New 7„!,. Gas <br /> CO TRAC PRICE OF WORK �i� CIN OF EVERETT LOCAL SALES TAX CODE IS 3 OSer <br /> C/ <br /> WORK DESCRIPTION ! -} I, r/'l� f�Nle �/� //C/�/� v�`�/`J� UIl���r �O�f����� <br /> L ]���1 <br /> �Y <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET A/C-A/IiANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> � �I�AVATORY(WASIi BASIN) HEAT PUMP <br /> � SHOWER — �NIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL — C2pTHES DRYER <br /> DISHWASHER RAa�E HOOD <br /> • LAUNGRY TRAY � WATER�-IEATER <br /> CLOTHES WASHER , METAL FI��LACEISTOVE <br /> � URINAL FIREPLACE INS RT <br /> - DRINKING FOUNTAW GAS FIREPLACE <br /> FLOOR DRAW GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> �L SINK(SERVICE/BAR/MOPIETC.) EXHAUST FAN . <br /> OTHER OTHER <br /> I <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANU CORRECT. ALL <br /> PF7VISIONS OF LAWS AND OkIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOl THE GRANTiNG OF A PERMIT DOES P10T PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANC�L THE PROVISION OF ANY OTHER <br /> STATt OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROP TY TO PERFORM THE WORK FOR NhiICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT S LAW 7 RCW AND 296.200 WAC. <br /> Signature o C r /A orized Agent D�I�� <br /> � L <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />