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�CRMIT APPLICAT�JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS E✓Oil�'j j <br />200 "7 /s�UKIL�O at✓. c to3 <br />LEGA LOT N0. BLOCK TRACT <br />DESC. � 5 M�P <br />PARCEL TAX I.D. N PERMIT w <br />�/?�o_oos-oo3-000-z Cc�3d,2-D�-' <br />or �LJriCt�br1 <br />�ii��F s�,Tuu•a r,��o,.�,urzC �07 M�M�VN-ad a�r//� 9��3 �Lr- �lo -Y-cBs_ <br />TENANTNAME DCONTACTNAME PHONE <br />/��/./ /�ii/� 1'�Ba <br />S�y c�.r # �Zs_ �`�sr- �3� <br />CONTRACTOR <br />� <br />PHONE <br />PROPOSED USE OF BUILDING <br />{2�51 DEN�� <br />CONTRACT PRICE OF WORK <br />ADDflESS <br />Buildino Mechanical <br />PERMIT � Combination � Plumbing <br />TYPE Demolition Sign <br />Sprinkler <br />con�rn. uceNse • <br />Additian <br />Alteration <br />New <br />RepaidMelnt. <br />HEATSOURCE <br />Electric <br />Ges <br />Other <br />CITY OF EVERETr LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />iQvnMEC. f_xi57.uL; l�u�`.'�%,i»ec{f�iae-L, /urcN��, i,�ip4 r�•��/L_ <br />E3c�/tioa�» A>'-� • �G1� 7 7� i2' �71� �� f � i� Lr/� f"`� �o'qe-�/ <br />NO. I TYPE OF FlXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCI�EN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF flXTURE OR REM <br />A/C — A/HANDLING UNITS <br />FORCEDAIRSYSTEMS /).�.���j,f��� <br />HEAT PUMP �'�` <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN � _ <br />OTHER � <br />4 <br />�� �iT'F..6��N <br />I HEREBY CER�TIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROV�SION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF TIiIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTR TOi�S LAW 18 7 RCW AND 296.200 WAC. <br />' 1 �,l�.v��� i �� ���c3 , <br />Sig at e neUC n or/Authopzed Agent ate� /�t. <br />� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />