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�- _ <br /> PEF '1111T APPLICATIOI�' I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 <br /> I� G�{07 —OU� <br /> SIT�ADDRESS PARCEL TAX I.D.# PERMiT u <br /> ' ")i�, ��,��,ai' � ���, �,� � � . I, ��'�i � � KG�I �IoC � L'ro �— _ - � c- <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS ZIP PHONE <br /> \ <br /> ' - � �n �<•cc '� ,kv��� (��� S �`I � I��laih �-� . S:�r lGI f�c�n��n-_�-� � (�--- `14�e� c� � <br /> TENANTNAME�� CONTACTNAME PHONE <br /> i_j;; ,,,�il':%�"'`-1 rt ( II'� il �%11<�-1'— i.�� - �"1?� � 2� �iC� <br /> CUNTRACTOR ADDRESS ZIP CONTR.LICENSEN I <br /> �� ^� 4��: 'i� I �I�� (�1'D�<< I���' r: ,1��1G� %1C�1 7b�� /�U� �F. "Tli(�"i��� � ,',�:;� �i�-r; �� Pft-TF=�IF{-'L�cic1C�� � <br /> PHONE � _ . _.�.,i �. '7i' � i/ <br /> '� � �J � l�L"�IL I�� �' I; I <br /> � PROPOSED USE OF BWLOINf I Buil�ing � M�chanical - nddii�on HEAT SOURCE � <br /> i <br /> PERMIT R{._( Com inati0n � Plumbing WORK Alteralicn (] Electric � <br /> TYPE �.j Demolilian U Sign 1YPE New D Gas I <br /> U Sprinkler Repairiblaint. U Other <br /> i <br /> iCONTFACT PFICE OF WORK �j' � I �'�;��, CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> WORK DESCRIPTION ' ;� <br /> � ,,;-; ��� �,� i �� �-� � ��- ,,� � i,� ;, �_� �r;,- -�, �i� +��,�;�; � <br /> , , <br /> ;;�� ��<<<t:� � <br /> PLUMBING N'iECHANICAL <br /> � N0. NPE OF FIXTURE OR ITE�d N0. IYPE OF FIXTURE OR ITEM <br /> ' WATER CLOSET _ A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> ' _ LAVATORY (WASH BASIN) HEAT PUMP <br /> � SHOWER UNIT HEAT[RS <br /> KITCHEN SINK& DISPOSAL CLOTHES DFYER <br /> _ DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY _ W1TER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAW . GAS FIREFLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK (SERVICE/BAN/MOPlETC.) _ EXH.4UST FAN <br /> OTHER OTHER <br /> — — I <br /> I <br /> I <br /> I HEREBY CcPITIFY THAT I HAVE READ AND EXP.h71NED THIS APPLICATION ANO KNOW THE SAk7E TO BE TRUE AND CORRECT. ALL I <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED WITH WHETHEFi SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEF�dIT DOeS NOT PRESUM1IE TO GIVE AUTHOflITY TQ VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULr1TING CONSTRUCTION OR THE PEriFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR12ED BY THE <br /> OWNER OF THIS PROPERN TO PERFORh1 THE`NORK FOR WHICH APPLICATION IS h1ADE AND I COMPI.Y WITH THE STATE I <br /> ?RACTOFS LAW 1827 RCW AND 296200 WAC. <br /> i <br /> � <_[ . ��_ �li� C --�—_-- ����L:��,.� _ <br /> Signature of wne/CoNractodAuthonzed Agent Date ' �� /� <br /> r <br />