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� <br /> �ERMIT APPLICAT�ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADORESS PARCEL TAX I.D.# PERMIT# <br /> �°/b S�. mo3 i r- d� <br /> LEGA �OTNO. BLOCK TRAC7 <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> 0 03 - �1�'s9 <br /> TENANT E I CONTACTFORPERMIT NONE' <br /> CONTRqCTOR C ADDRESS <br /> � /�933-59'� /4�Z�P CONTR.LICENSE N <br /> PHONE �/ � `�/3s—�3S� ��0� 9�i3 sharnNNoglBe <br /> (rJ <br /> PROPOSED USE OF BUILDING Building MOChan(Cal Adtlitlon fiEATSOURCE <br /> PERMIT � Combination �Plumbiny WORK B qlteretion � Electric <br /> TYPE Demolition Sign TYPE D New Gas <br /> Sprinkler U RepairlMaint. Other <br /> IcONTRqCT PRICE OF WORK ��� � CI7Y OF EVERET7 LOCAL SALES TA7(CODE IS 1705 <br /> WORK DESCRIPTION ^� � L�F/-' - __ n <br /> �� , Zr'!/�'OSX <br /> PLUMBING MECHANICAL <br /> NO. T/PE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> _ BATHTUB Z FORCED AIR SYSTEMS <br /> _ LAVAT'�RY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNITHEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPIACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS R,qNGE <br /> _ BACKFLOW PREVEN-[R GAS PIPING <br /> _ SINK(SERVICE/BAPJMUP/ETC.) EXHAUST FAN <br /> OTHER — <br /> — OTHER <br /> I HEREBY CERITIFY 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 PEP,MIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TNE PROVISION OF ANY OTHER <br /> STATE OR LOCA�LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTFIORIZED BY THE <br /> OWNER OF IS PROPERTY TO PER ORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC S LAW 18.27 RCW AN 296.2P0 WAC. <br /> �9� S /i/3-O� <br /> SignaWre of 0 eNContractoNAuthonzed Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />