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�ERMIT APPLICATI�N <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 /> � /- C>�� Mo3o�-pL3 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS <br /> /- ZIP PHONE <br /> �r�x��-C� rlva�t !� ���� rJil�t� �i� �`d�J�S y�G o27 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR y� ,�,� /�J_ _,n�7,s ppDRESS Q d ��. �� ZIP CONTR.L�CENSE# <br /> civ Cl�J(/<c r� ���n /�q <br /> PHONE/� '� .�/ % '-'zJ�37� �J� J%'CUC�S�/�C�C� 7t70?JJ �~(> �F���'( / <br /> 7� <br /> PROPOSEDUSEOFBUILDING pERM1T B COrtlbi atiotl'D p9nbingal TMPE Newi�uun HEATSE eR'nCc <br /> � TYPE D Demolition p <br /> �,� �� �ut� r � Sprinkler Repair/Maint. �0 her <br /> CONTRACT PRICE OF RK �O� tG CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> r <br /> WORK DESCRIPTION <br /> �-�6/4'Ge �r S�?�Q �/{'cTv'l C �c/Q'l�i� l�f,e4 7��' <br /> J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE 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& DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY � WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE 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 — <br /> — _ OTHER <br /> I <br /> � I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br /> I PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS.TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED 4EREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVIS�ON OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CON RUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFO THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT RS 1827 D 20 AC. <br /> �'��9�3 <br /> S n ur of Owner/C trec u orized ent Date <br /> D IT & CREDIT CARDS ARE NOT ACCEPTED <br />