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P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS P RCEL TAX I.D.# PERMiT# <br /> il� �} rrl�,;� Jr� D� 3 aa o�303�� S o�03 � oc� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> WNER ADDRESS (1� � � ZIP PF{ONE <br /> �,�,;;ro Ot 1,P Sw✓ ��1 1��5 s. B�� � Gt �i��o (3�Z����`��C1 <br /> TENAN NAME ,� CONTACT FOR PERMIT PH� �• � <br /> � ���,� C . f'(�n(t � `���" �]�� <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE N <br /> PHONE <br /> PROPOSED USE OF BUILDING � Building I"') MeChanical Addilion HEAT SOURCE <br /> PERMIT Combination K Plumbing WORK R Alteration D ElecVic <br /> TYPE Demolition L/ Sign TYPE C] New � aas <br /> C�J�C Sprinkler U RepaidH�:�nl Other <br /> CONTRACT PRICE F WCRK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> � d <br /> PLUMBING MECHANICAL <br /> NO. 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 /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWP.SHER _ P,ANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPIACEISTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUN fAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER ,_ GAS PIP�NG <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> � I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> �I PROVISIONS OF LAWS AND ORIDINACcS GOVERNING TMIS NPE OF WORK WILL 8E COMPLIED\NITH WFiETHER SPEGFIED HEREIN OR i <br /> i NOT. THE GRANTING OF A PERMIT DOES NOT PRESUAtE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> I STATE OR L L LAW RFGULATI CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> � OWNER�F H�5 PROPERTY TO RFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRA T R'LAVIL1B.27 RCV D 296.:00 WAC. <br /> ' c <br /> �,' L . � a7 � <br /> Signatur of ner/Conlractor uthonzed P.gent Date �i <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />