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PtRMIT APPLICATI�UN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> i�C?� ��1''A!:�I`' ;/'�� G — OD <br /> LEGA LOTNO. BIOCK TRACT <br /> oesc. .. �' y 19� ;1 <br /> OWNER ' ' =U{' . �:�' .'i %�/ , <br /> ADDRESS ZIP PHONE <br /> . � , �, ,, � �/i���.; �; � ��o ! y�?S�2i� �IS�I <br /> TENANTNAME/ / CONTACTFORPERMIT PHONE <br /> coNrw� o '/� I F >>S Hs�tiia =j�S� ,�/ - //$`� <br /> ADDRESS 21P CONTR.LICENSE N <br /> PHONE <br /> Or�J,v s;Z <br /> PROPOSED USE OF BUILDING {� Building PAechaniCal Additlon HEAT SOURCE <br /> PERMR n CombinaQon � plumbing WORK � Alteratlon � Eiectric <br /> TYPE D Demolition Sign TYt+E New Gas <br /> C!�� i) 1 ' U Sprinkler RepairlMalnL Other <br /> CON CT PRICE OF WORK ./it'SO�— CITY OF EVERETT LOCAL gqLES TAX CODE IS J105 <br /> �7 (i / <br /> WORK DESCRIPTION <br /> i <br /> � • <br /> � . / <br /> C��::l i�,r; - /v ';( !�� C.�,�1.;:���. /�`�� .� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR 17EM <br /> _ WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNITHEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER _ RqNGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DR,qIN GAS RANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER <br /> — 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 LqWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETNER SPECIFIED HEREIN OR <br /> NOT. THE GR4NTING OF q pERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TME <br /> OWNER OF THIS PROPERTY TO PERFORM TNE WORK FOR WHICH APpLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CO ORS LqW 1827 RCW AN 296.200 WAC. <br /> Sig at�neq�dAuthonzed Agent uGfJl�Daf �.� <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED �2- <br />