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P RMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 � ' /�' ` O b, <br /> �f <br /> SITE ADDRESS PARCEL TAX I.D.� PERMIT N <br /> er�/d� ✓-e - <br /> E LOT NO. BLOCK 1RACT <br /> DESC. <br /> OWNER �j.- l ADDRESS ZIP PN E <br /> �l/Py�GI �va��� �Cc��J�� - <br /> 7ENANTNAME 5/4'/✓ES r''� ry/Mc1 CONTACTFORPERMIT PHONE <br /> � e .`c li2r i` .� S - (�_ <br /> CONTRACTOR /l1/ �- 'y2,7 � DRESS ZIP C Nl�(t.,��LKP7�2 <br /> � ,(X� <br /> PHONE I�{' (/ /_ C Ip � O� C✓ L (1� 0 <br /> tl <br /> PROPOSED USE OF BUILDING Building Mechanlcal Addltlon HEAT 80URCE <br /> PERMIT R Combinetbn �Plumdnp WORK B Nteretlon D EkcMc <br /> iYPE D Demolition Sign TYPE D Naw D Gu <br /> U Sprinkler U RepalrlMalnt. U OIMr <br /> CONiRACT PRICE OF WORK n 71 D p � CITY OF EVERETT LOCAL SALES TA%CODE IS 7705 <br /> 1 ,b�c- <br /> WORK DESCRIPTION /h S,�.� �� �- s,y�/< � /- µw t�/- T�C�- � ti+��°�', ����'T� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FU(TURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK BrBfSPOS7IL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <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 sr� rt'�ti.t".�. _ OTHER <br /> � /-fWt� — <br /> �, i'�'.�P _ <br /> I HEREBY CERITIFY THAT I HAVE REAO AND E%AMINED 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 MEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE PROVISION OF ANY OTHER <br /> STATE OR LOCAI LAW REGUL?.T�NG CONSTRUCTION OR THE PERFORMANCE 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 TOR�8.27 RCW AN 296.200 WAC. <br /> � �� • <br /> Signature o OwnerlConl�crodAuthonzed Agent ate <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />