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r � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT S�RVICES <br /> 3200 GEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 �j � , _ <br /> �a D Oo.6 <br /> SITE ADDRESS PARCEL i AX I.D.N PERMIT X <br /> 3115 l��.. ': v� ����-� <br /> LEGAL LOTNO. BLOCK 7RACT <br /> DESC.r <br /> OWNER ADDRESS DP PMONE <br /> CC.,\) <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CGr�e,.,�9�� I �ia�- -�.o���.: �, (a53)37'� -�7aA� <br /> CONTRACTO �_L� ��,,,. I��4,`�� ADDRESS�a�jj � ryy �(, 5� �P�^ CONTR.UCENSE�R <br /> �'•1t d�.�c. <br /> n -.��n r ����� r- <br /> PHONE I ��73��7d- N"f�}- ��_� �'`� �-GN�l�I '�Iq' <br /> \ y� <br /> PROPOSED USE OF BUILDING I TMPEIT � C�Pm kilnaot�on U ,\I9 bing ' I�E �/ RepairMlaint. I M�� �eric <br /> ` U <br /> � `'��\ U <br /> CONTRACT PRICE OF WORK � C�TY OF EVERETT LOCAL SALES TAJ(CODE IS�105 <br /> WORKDESCRIPTION �.�� ` Q�?d /yjOp�itiLctf-„1/'IOt p)G15jiYly <br /> 1�5�t1�a+;��. o� no�.� SP � I- 1�a.+�s <br /> 5�r�vl�.lc.r5z Accrn�.�..u��.-� �1�w oC-E'�c.� Nd�1���bn: ��c' ���r���F-1�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> IAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 OISPOSAL CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METALFIREPLACFJSTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPIACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKfLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/8AR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> �HEREBV CERITIFY THAT�HAVE RFAD AND FXAMINED T111S APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPt OF WORK WILL BE COMPLIE�WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES N0T PRESUME TO G�VE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION O�AtJY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANC[OF CONSTRUCTION. iHAT I AM AUTHORIZED!3Y THE <br /> OWNER OF THIS PROPERIY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTR TORS LAW 18.27 RCW AND 296.200 WAC. <br /> ,�� ����� � �/J` L� <br /> �Slgneture o__ � nt or/Authonzetl gent ate �L <br /> _ DEBIT& CREDIT CARDS ARE NOT ACCEPTEO <br />