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f�ERMIT APPLICAT �JIN <br /> �'� CITY OF EVERETT PERPr'T SERVICES <br /> i 3200 CEDAR STREET, EVEr."_ . ,, dVA 98201 �` ��7�� <br /> I425-257-b810— FAX 425,257-8857 7 <br /> I SITE ADDRESS PARCEL TAX I.D.k PEPtd1T x <br /> � i , ..,� � . -' � 0 C ��- - .J`. � <br /> 1 i ; %�. ' ��•." � O,J '�`� I <br /> LEGA LOT NO. BLOCK TRACT r , <br /> � <br /> � DESC. _ _ �,: ....,�� -. /r�.� �- �j �I�� N- '�7 [9.�' I <br /> � .� . � <br /> OWNER ' ADORESS 21P PHONE <br /> I i - / .�. , �. • <br /> - , ! , �/.�7 ' .'�.� " � -i, �� i.��.'�.(�: ! f/� I,. ��f!I�J 7 . '%.� �� '�i�^��„� ���.-.:o'I <br /> TENANT NAME CONTACT NAPdE PHONE , <br /> . - � -/� ' <br /> . . . . . . ��. . ". ° � _ � <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# i <br /> , .`i-�, . I, <br /> PHONE -. � - ' ' � I <br /> i <br /> PROPOSEDUSEOFBUILDING Building f'1 MeChdniCdl f� Adtlition I HEATSOURCE �I <br /> I ' - PER�d1T Combination �__� Plumbing WORK �_� Aiteration � Elecxric , <br /> I � . � � � ��� TYPE Dem01ili0n U Sign TYPE j� New Gas , <br /> I i Sprinkler U ReaaidMaim. Other <br /> CONTRACT PRICE OF WORK i(-' / CITY OF EVEREfT LOCAL Si.LES TAX COOE IS 3105 � <br /> . � `> '; I <br /> WORK DESCRIPTION � , <br /> l�. , .. '�i�r . , ii �y� l i/l ��'� .�(>r; �, r'o:�;:�G G l7O[�jG � <br /> PLUMBING � MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM IJO. TYPE OF FI%TURE OR ITEM i <br /> WATER CLOSET A�'C-A/HANDLING UNITS II <br /> BATHTUB _ FORCED AIR SYSTEt�1S <br /> LAVATORY(WASH BASIN) HEAT?UM�' � <br /> SHOWER _ UNIT HEATERS I <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER i <br /> DISHWASHER _ RANGE HOOD <br /> I _ LAUNDRYTRAY _ WATER HEATER I <br /> CLOTHES WASHER _ METAL FiREPLACE/STOVE ; <br /> URINAL _ FIREPLACE INSERT i <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> i FLOOR DRAIN _ GAS RANGE <br /> ' BACKFLOW PREVENTEA ,_ GAS PIPING � <br /> SINI<(SERVICEI6AR/MOP/ETC.) _ EXHAUSTFAN � <br /> i — <br /> OTHER _ OTHER <br /> � — <br /> — I <br /> I <br /> I NEREBY CGRITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SA1dE TO BE TRUE AND CORRECT. ALL �i <br /> PROVISIONS OF L1WS AND ORIDINACES GOVERNING THIS NPE OF WORK INILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR j <br /> tJOT. THE GRANTING OF A PEPMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER i <br /> STATE OR LOCAL LAW REGULATWG CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I Aki AUTHORRED BY THE , <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE i <br /> �. CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> I : ��..' <br /> I <br /> . . ,'. . ,_ ��.� . � <br /> Signsture of OwnenConiractor/Authonzed Agent Date � <br /> L <br /> DEBIT & CREDIT CAR�S ARE NOT ACCEPTED <br />