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�ERMIT APPLICA�t�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 3 vr/`�.3 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT a <br /> �%D i 'E,c/�l �l/� �-- (� 3� o - �'`�� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 ZIP PMONE <br /> J�.Jv—,C�iN� �i��STi���v'-r's /9910 �/�� 99 �'t � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Gy�.v.,�c���� wA ���>3 � �:��— �9 7 — �l f� S <br /> CONTRA�TOR� w/��L ADDRESS ZIP CONTR.LICEN9E K <br /> (t�/v �,�!/��",�- <br /> PHONE ���_ ��JCj —O��'�v <br /> PROPOSED USE OF BIIILDING (� Building D Mechanicai �Additlon HEAT SOURCE <br /> 17���� PERMIT K Combination U Plumbing WORK Alteration I7 Electric <br /> �� TYPE �..1 Demolition U Sign TYPE New � Gas <br /> � �5�� �- u Sprinkler RepainMaint. Otner <br /> CONTRACT PRICE OF WORM�'3�� �p CITY OF EVERETT LOCAL SALES TAl(CODE IS�tOS <br /> WORK DESCRIPTION <br /> Gur vcc7- d�D I'��c,V,o.✓rc-,qc iG.� ��s�e�ou� t�q�e�•9� � <br /> �✓a Co�JG�,e �S G(.S� �V�/D �PA/�2 c�S�idC..L <br /> � <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FI%TURE OR ITEM NO. . TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ AIC—AlHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TR,4Y WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIfY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WFiETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PER611T OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATIN NSTRUCTION OR Th1E PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF PERTY TO RF RM THE WORK FOR WHICH APPLICATION IS MADE AhD I COMPLY WITH THE STATE <br /> CONTR ORS 18.2 R AND 6.200 WAC. <br /> � i� a� 03 �(� <br /> Signature of Owner/Contracto onzed Agent Da <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED '3 - <br />