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\ � <br /> PERMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA S8201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.#� PERMIT f! <br /> � s� m o 3o to-c <br /> LEGA LOTNO. BLOCK 7RACT <br /> DESC. <br /> I OWNER ADDRE53 LP PMONE���a,��_ <br /> 1�� p P�.k�� �ao� G�,� A�,��a �_�.�o a$ao� <br /> TENANT N�, , � I CONTACT FOR PERMIT _ PNONE <br /> �'ctnc...� 1�.�v�•�rmntiS N76S-T�I — Y381 <br /> CONTRACTOR ADDRESS r 21P CONTR.LICENSE R <br /> L1M. 1��� 1��5 P�F-e�na,�w� �3,c�an�c� v��• �6iCdo\ <br /> PHONE � „w ���.I.� �.�p�Q <br /> G�ys - 7 '�[ - 43F� i �.,.-� v r � <br /> PROPOSED USE OF BUILDING Building �MBChaniCal AEOition j uSAT SOURCE <br /> PERMIT � Combination Plumbing WORK B PJteration I D Electric <br /> TYPE Demolition Sign TVPE D New D Gas <br /> Sprinkler U RepaidMainL U Other <br /> CONTRACT PRICE OF WORK �.,�/� T�� CITY OF EVERETT LOCAL SALES TAX COOE�S J105 <br /> S.CJ6JS! � � t� <br /> WORK DESCRIPTION <br /> E-L�z�� �'G� �"---���� � <br /> PLUMBING MECHANICAL <br /> NO. � TYPE OF FlXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ AIC—AIHANDLING 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 TRAY WATER HEl �ER <br /> CLOTHES WASHER MFTAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DR�NKING FOUNTAIN GAS rIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _, EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CF.RITIFY THAT I HAVE READ AND EXAMINED THIS APPIICATION hND KNOW THE SAME TO BE TRUE AND CO!tRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF V:ORK WILL BE COMPLIED WITN WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TQ VIOiATE OR CANCEL THE PROVIS:ON OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> UWNER OF THIS PROPERTY TO PERFORM THE WORK F^4 WHICH APPL�CATION IS MADE AND I COMPLY WITH TNE STATE <br /> CONTR4CTORS LAW 18.27 RCW AND 296.200 WAC. �� /� <br /> C'a��z ���l� / <br /> Signature of Owner/Co tr tod uthonzed A ent Da� <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />