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�CRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SE::�ICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.f� P Mi7 n <br /> . - ovo ,�w� , 30 3 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS ZIP PHONE <br /> / n /� , � <br /> S�J�Lp^-�`'� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> F �nn� ..-rr ��1��. IL1P,L�(L �lLS - SI9-73y2. <br /> L---iv��n r u��G Z�p CONiR.LICENSE• <br /> CONTRACTOR (�- / ADDRFSS <br /> �C�l_ <br /> PHONE sE <br /> y�..�-tis�t- Po�z� t.s'yos' a��'' s��rZm B�c1.E✓�!� <br /> PROPOSED USE OF BUILDING Ibt�Building I") Mechanical Additlon I HEAT SOURCE <br /> PERMIT K Combination H Plumbing WORK �Alteratlon �Electric <br /> TYpE �_� Demolition LJ Sign TYPE New Gas <br /> ;� ., , _ LJ Sprinkler RepaidMaint. ONer — <br /> � <br /> CONTRACT PRICc OF WORK ��^�I� CITY OF EVERETT LOCAL SALES TA7C CODE IS 3705 — <br /> WORK DESCRII�TION <br /> u � E r MECHANICAL <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C-AIHANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> � KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HO00 <br /> LAUNDRY TRAY _ 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 CERITIGY THAT I HAVE RFAD 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 WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAV�'REGUlATING CONSTRUCTiON OR TfiE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT CTORS LAW 18.27 RCW ANO 296.200 WAC. <br /> �� �� `�.�� �i�l� 'I <br /> Signature of OwnedContractorlAuthonzed Agent ate Z <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />