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/ <br /> P`tRMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREFT, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> Iq� <br /> SITE ADDRESS , PARCEL TAX I.D.� PERMiT# <br /> LEGA LOTNO. BLOCK TRA <br /> —1��-�`�����1�' nh G o y�� - oo� <br /> DESC. 9 `J�U � �.NG�t.r � <br /> OWJ+I�R AUDRESS ZIP PHONE <br /> � � <br /> ���GlCar , I-�o,��s 1�M� A- y(, �LI S25 �C l� S�E�Ns wA 9�ts:. <br /> TENANT NAME CONTACT FOR PERMIT pHONE <br /> � U�a+ l�vo�l �yz�� 299 - a8�� <br /> CONTRACTOR ADORESS ZIP CONTR.LICENSE M <br /> PHONE <br /> PROPOSED USE OF BUILDING I Building f'1 Mechanical AOdition fiEAT SOURCE <br /> I�i C PERMIT � Combination �_� Pl9mbing WORK e PJteration � ElecMc <br /> �1 �� �l TYPE Demolition LJ s� � �e � New Gas <br /> Sprinkler d Repair/Maint. Other <br /> CONTRACT PRICE OF WORK I W� OC/V ������ CITY OP EYERE?T LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> / / � <br /> l�le �..) �'<,,as �t al�.. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET(TOILET) _� AIC—A/HANDLING UNITS <br /> L BATHTUB � FORCED AIR SYSTEMS <br /> '� LAVATORY(WASH BASIN) —T HEAT PUMP <br /> � SHOWER U UNITHEATERS <br /> I KITCHEN SINK&DISPOSAL I CLOTHES DRYER <br /> � DISHWASHER 1 RANGE HOOD <br /> �� LAUNDRY TRAY I WATER HEATER <br /> I CLOTHES WASHER U METAL FIREPLACE/STOVE <br /> C URINAL O FIREPLACE INSERT <br /> �! DRINKING FOUNTAIN J_ GAS FIREPIACE <br /> �' FLOOR DRAIN 1 GAS RANGE <br /> '% BACKFLOW PREVENTER � GAS PIPik, <br /> � SINK(SERVICE/8AR/MOP/ETC.) � EXHAUST FhN <br /> OTHER OTHER <br /> I HEREBY CERITlFI'THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVI:�ONS OF IAWS AND ORIDINACES GOVERNING TNIS TYPE OF WORK WILL 8E COPAPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> N07. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCF OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF?HIS�PROPERTY TO PERFORM THE WORK FOP.WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRF,CTORS LAW 5827 RCW AND 296.200 WAC. <br /> �_ /� 1,:+�i`'� � ll � `f , <br /> Signature of Ow dContractodAut iorized Agenl le Gl u��'a � �i <br /> � �. v�EBIT 8 CREDIT CARDS ARE NOT AGCEPT�D ���"OSZ� <br />