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PtRMIT APPLICATIUN <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 a <br /> .-�;; ; ' C'rJ- C ��/C' �'1 D3 v9-D3 �i <br /> LEGA LOT NO. BLOCK TRACT <br /> �ESC. II <br /> OWNER AODRESS ZIP PHONE <br /> -,— . <br /> ,��,�hel le i� � I�I-�I� ;��=�� G_zV.c=� tl�%�i�:�C l �I�S- 51- " ;,� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ���, �� � �= ����� � �,�i ��� -���, � �-�_ �i-�.,�5�- ��<,�.� <br /> � ��- i�=,����I� <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> PHONE �l.(//�/� <br /> PROPOSED USE OF BUILDING pERM1T � Sprink�leation � Plumb ng�� WORK �Repa nMaint HEAT S�U�RCE <br /> TYPE Demolition Sign TYPE New �Gas � <br /> Other <br /> CONTRACT PRICE OF WORK Ll�?,`L.c_,1i ,ZL��� �� CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> J� <br /> WORK DESCRIPTION � <br /> I <br /> I <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 FURCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> i KITCHEN SINK 8,DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINA� FIREPLACE INSERT_�I� <br /> _ DRINKING FOUNTAIN � GAS FiREPtREE S �iv Pi I <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER � GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> ! — — i <br /> — I <br /> � I HEREBY CERITIFV THAT I HAVE READ FNO EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL I <br /> � PROVIS�ONS OF LAWS AND ORIDINFCES Gt�VERNING THIS TYPE OF WORK\VILL BE COMPLIED N'ITN WHETHER SPECIFIED HEREIN JR � <br /> NOT. THE GRANTWG OF A PERMIT DOES NOT PRESUAIE TO GIVE AUTHORITY TO\'IOL4TE OR CANCEL THE PROVISION OF AN'/OTHER i <br /> STATE OR LOCAL LAW REGULATING CON3TRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I APd AUTHORIZED BY THE <br /> JWNER OF THIS PROPERTY TO PERFORM THE 1NORK FOR 1VHICH APPLICATION IS NADE AND I COMPLY WITH THE STATE � <br /> � CONTRACTORS UiW �827 RCW AND 296.200 WAC. <br /> �i r <br /> � � ` 7 � <br /> � ���-I�,l�k�������k ���c i, ��a �I - �� � <br /> Signature of OwnedContrectodAuthonzed Agent Date , <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />