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P�RMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-881�-FAX 425-257-8857 <br /> SIT�ADDRESS PARCEL TAX I.D.N P MIT# <br /> �yos U�Ks A�� �oa ���� <br /> IEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �PU� Q R��'`''�� � `'1 V S OR I�S A �'E g 8'20"� Zob- 390 -yb� <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> [/� /zooFf2 Zo6 - 9��- S'�9y <br /> CONTRACTOR P ROb F�� ADDRESS 21P CONTR.UCENSE� <br /> PHONE 1 ��� 2 AIN r�. R�• 9Sra9� . AR°of� �q40 <br /> Zc�t� -99q- s��9y �I� <br /> PROPOS[D USE OF BUILDING I� Building Mechanfcal AddlUon HEAT SOURCE <br /> PERMIT �� Combination � Plumbing wORK � Alteratlon (� Elechic <br /> � h L TYPE K Demolilion U Sign TYPE New Gas <br /> �z S� o_v71 A v sprinkier Ropp�N G RepairlMaint. Other <br /> CONTRACT PRICE OF WORK '7 S'OO � CITY OF EVERETT LOCAL SALE9 TAX CODE IS 3105 <br /> / <br /> WORK DESCRIPTON <br /> llf�i,,J �OF <br /> PLUMBING MECHANICAL <br /> NU. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR IiEM <br /> WATER CLOSET(TOILET) _ A1C—A/HANDLING UNITS <br /> BATHTUB FORCED PIR SYSTEMS <br /> LAVATORY(WASH 8.4SIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES ORYER <br /> OISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES�A'ASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> �CKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREdY CERITIFY THAT I H.4VE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CCRRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WFiETHER SPECIFIED HEREIN OR <br /> NOT. THE G NTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR L AL LA EGULl+TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNEF OF HIS P PE TY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRA RS LA 18.27 RCW AND 296.200 WAC. <br /> �- ^) � -0 � <br /> Signa re of OwnedContractodAulhonzed Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />