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PERMIT APPLICATtO[V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS E�"�E�� �"'�1� PARCEL TAX I.D.# PERMiT# <br /> =�Y-/� —�w2�nl �C 98�01 Mv3o5-ti�z <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> � - 92S-zs�s�36 <br /> f�2�,�ni i�u1�cH �`r`/9~rNo�e�.v ME' F��2E7Tw,1 9P2a1 c - ;toc-22bo6 �p <br /> TEN TNAME I CONTACTFORPERMIT � PHONE <br /> s"qM E s.�M f <br /> CONTRACTOR ADDRESS ZIP CONTR.L�CENSE N <br /> �iH�jH �oN-�ZUc710� !6 f2'J- 2/� AR. S,E, <br /> PHONE Z - �S�S'M l <br /> 5�13�� 3�76�`� FuekE'CTI �^'?• 9&20� <br /> PROPOSED USE OF BUILDING � Buildiflg � Mechanical AddiUon HEAT SOURCE <br /> PERMIT CPmbination Plumbing WORK � PJtPration � Electric <br /> `-, � TYae Demolition Sign 7vPE New Gas <br /> r S rinklef Re aidMaint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> WORK DESCRIPTION <br /> rQEI��/9�E w,�[/� /tE�f'IZ-�2 CF�7��c� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <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 RANGE HOOD <br /> _ LAUNDRY TRAY % WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPIACE 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 CERITIFY THAT I HAVE READ 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 LAW REGULATING CONSTRUCTION OR THE PERFORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERF0�2M THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTO W 1827 CW AND 6200XVAC. <br /> /" �� 6� <br /> Signa ure o Owne t ori e Agent ate <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED mO`3pS"00 <br />