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� <br /> �-ERMIT 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 PARCEL TAX I.D.N P RMIT s <br /> a6 � ar � C 'ul DO - IfS - 0 O -oo -C�� <br /> LEGA LOT NO. BLOCK TRACT (�(q-(- e �' [–'�/p y.v � U�S 1 o f <br /> I� �� Ttif N[C � <br /> DESC. �i � a � acco� • -/� -f4e 14 f- eo ca ` u � 7 <br /> OWNER ADDRESS Z�p PHONE o �' ��l@�3O <br /> / / �/ �/ �� �i�. <br /> l�h�c� f� rlilq .�S/� �,�oar /�� EUet'r � Wa 9cy�Oz <br /> TENANT NAME CONTACT FOR PERMIT O W �Le N PHONE <br /> I D�3�� bs3-8'l z 7 !� L<�s� .�y 7 ��>q <br /> CONTRACTOR AODRESS LP CONTR.LICENSEN <br /> PHONE D� �/l, Q.�t/" <br /> �� ��e <br /> PROPOSED USE OF BUILUING PERM�T B Sprink'leation B S 9n ti ngal TMPEK B NePair/MeinL HEAT SG�RnE <br /> J 1�G2 7YPE Dem0lition � IJ omer <br /> � <br /> CONTRACT PRICE OF WORK ��� — CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> WORKDESCRIPTION S�LI QC �. ` � �r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE CR ITEM NO. TYPE OF flXTURE OR fTEM <br /> _ WATER CLOSET A/C–A/HANDLING UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(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 _ METALFIREPLACFJSTOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLQW PREVENTER _ GAS PIPING <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 /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHEF SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOR�TY TO VIOL4TE OR CANCELTHE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTQRS LAW 18.27 qCW AND 296.200 WAC. <br /> / . .Z 0.3 <br /> Signatur f Owner/ContractoUAutho ' Agent ate <br /> � EBIT & CREDIT CARDS ARE NOT ACCEPTED <br />