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PtRMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> _�/n7- /h4K�n PL <br /> SITE ADDRESS PARCEL TAX I,D.# P IT# <br /> �,�K �s i �'D��Z <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS ZIP PHONE <br /> Q.��,,. �, (�� k,•.� ��o�� rn9h�� p� F'u.� ll i,.,ti 98��t� <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> Oa- 5 �-��.n.,s�T _ i�� T ��.,� <br /> yzs- 3 s 3-!o YG. <br /> CONTRACTOR ADDRESS � 21P CONTR.LICENSE# <br /> PHONE �G•' 7ESG• ��� / �ULG�' �QL� �� �L �4e� �/V0. !v/�� <br /> PROPOSED USE OF BUILDING fl Building Mechanical fl Addilion HEAT SOURCE <br /> PERMIT �_� Combination R Plumbing WORK �_� Alleratlon � ElecUic <br /> TYPE �l Demolition � Sign TYPE �l New Gas <br /> U Sprinkler U Repair/Maint. , Other <br /> CONTRACT PRICE OF WORK ,Up, �U J CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> �,� r,,,�:�„ ��,� r„s���ll �v. r�t�, F��, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TlPE OF FIXTURE OR ITEM <br /> _ WATERCLOSET(TOILET) A/C—A/HANDLINGUNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UtJIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> D�SHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS F�REPLACE <br /> FLOOR DRAIN CAS RANGE <br /> ACKFLOW 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 WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTIiORIZED BY THE <br /> OWNE TH PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONT AC W 18.� W AND 296.200 WAC. <br /> -,�/-U <br /> Signature of OwnedCo ctodAuthonzed Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOl'ACCEPTED <br />� <br />