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F��RMIT APPL.ICATIuN <br /> CITY OF EVERETT PEkAAIT SEFtVICES <br /> 3200 CEDAR STREET, EVERI:i T, 1,NA 98201 <br /> 425-257-8810- FAX 425=?57-8857 <br /> �TE ADD SS (�,, PARCEL TAX I.D.# PEttMIT# <br /> `'�i�. . �c,'. 5 ' ( vY',�u,`� I R�3o�-oa-f <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS � ZIP PHONE <br /> ��.���,��� �`�;��-�C� �a� �.���}�,�nu�, �,o�, i r`�ol.�/� <br /> TENANT NAME CONTACT FOR PERMIT T^�� PHONE <br /> I �`��25Z.-i��S <br /> CONTRACTOR ADDRESS ::IP CONTR.UCENSE 8 <br /> PNONE <br /> PROPOSED USE OF BUILDING Budding Mechanical �tditan HEAT SOURCE <br /> PERMIT B Combination�lumbing WORK Alk�ratiin �Electric <br /> 7YPE �� Demolilion '[�Sign 1YPE ew Gas <br /> D Sprinkler RepaciMe�nc Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES 7NC CODE IS 3105 <br /> WORK DESCRIPTION <br /> ��e �G�NC� �����1�'�' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C—AIHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <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 DRA�N GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I, I HEREBY CERITIFv 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 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 <br /> CONTRACTORS LA�N 18.27 RCW AND 296.200 WAC. <br /> Signature of OwnedContractor/Authonzed Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />