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�- P�RMIT APPLICATICyN <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.# PERMi7# <br /> ��0( ��Qr,c� flUC . Mo�ivS - U a� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> Nan CI�� K a.��'- 34`�`� <br /> TENANT NAME � CONTACT FOR PERMIT PHONE <br /> � 5�m� <br /> CONTRACTORrs �.A I—����i n� ADDRESS ZIP CONTR.UCENSE# <br /> l.i ��\ <br /> PHONE ?�� �\ — LG �7�l! I � I �_7 �1 �� �AICL�'/ <br /> v� <br /> PROPOSEU USE OF BUILDING f'� Building n Mechanical Addition HEAT SOURCE <br /> PERMIT �_� Combination H Plwnbing WURK Alleration R Electric <br /> TYPF �( Demolition Ll Sign TYPE New u Gas <br /> LJ Surinkler Repair/Maint. LJ Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 9705 <br /> WORK DESCRIPTION <br /> PLUMBING MECH�INICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEA1 <br /> WATER CLOSF_T(TOILET) _ A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK f,DISPOSAL CLOTH�.S DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHrR METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPIACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTY.ER <br /> �I I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNON�THE SAME TO BE TRUE ANO CORRECT. ALL � <br /> i PROVISIONS OF LAWS AND ORIDiNACES GOVERNING THIS NPE OF WORK WILL 8E COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> I NOT. THE GRANTING OF A PERMIT DOES NOT PRESUNE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> iSTATE OR LOCA�L4W REGUTATING 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 i <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. � <br /> S� I ��1�� �� <br /> Signature of OwnedContraclodAuthonzed Agent Date � <br /> � UEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />