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� PtRMIT APPLICATI(�N <br /> CITY OF E��ERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> SITE ADDRES PARCEL TAX I.D.� PERMii# <br /> 3/lS ;���, �c ve Pc�o� -daf <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDtt�SS ZIP f HONE <br /> G�u �.� � v ,�r� � <br /> TENANT N pCONTACi FOR PERMIT PHOHE <br /> (J-{�C r� �� /\G vi C1 ��l"G vt� �� r � ' /00 � <br /> CONT CTO ADDRESS ZIP CONTR.LICENSE M <br /> /�ll�'��e F'l�,ti. ����E tiE e��.,<,.� k��r�l, ���r,2 A,ccFNrrrozMo <br /> PHONE 9eo s,3 <br /> �-1G�1 <br /> PROP SED USE OF BUILDING f7 Building Mechanical Q Addifion HEAT SOURCE <br /> PERMIT �-� Combinalion � Plumbing IWORK ,My Alteralion � Eleciric <br /> I 1YpE j( Demolition Sign TYP� D New Gas <br /> LJ Sprinkler I� Repair/Mair.t. Other <br /> CONTRACT PRICE OF WORK /�/f'f � CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> V�/ <br /> WORK DESCRIPTION <br /> A/�,/ / ��� fll•�!` <br /> �7 C� <br /> PLUMBING MECHANICAL <br /> N0. 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 /> IAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRNY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACFJSTOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE I <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> � SINK(SERVICE/BAWMOP/ETC.) _ EXHAUST fAN <br /> OTHER _ OTHER <br /> I HEREBV CERITIFV THAT I HAVE RE.4D AND EXAMINED THIS APPLIGAI�ION P•ND KNOW THt SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINA�ES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED NEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIO:ATE OR CANCEL THE PROVISION OF PNV C:N[P. <br /> OWNEkOOF TOHIS P OPERTY OTPERFORM THE WORKOFOR WHICH PPIICATIONFS MADERAND I COMP Y W T'H THE S�TATE D BV THE <br /> CON�� /' 18 �A�96200 WAC. ��� I <br /> Signature o(OwnedContractor/Authonzed Agent Date <br /> DEBIT & CREDII' CARDS ARE NOT ACCE.PTED <br />