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PERMIT APPLICATION <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.A PERMIT N <br /> � ga6 Map►� sf � oi � - <br /> LEGA LOT NO. BLOCK THACT <br /> DESC. <br /> OWNER . ADDRESS ZIP PMONE <br /> �au/ " � �an�cl� ne V1Suy�i� i8�� Man/1 sh qgaai �yzs)'sO '3o69 <br /> TENANTNAME CONTACTNAME PHONE <br /> +� ° �GJa�t'��Li;�P ��So L` Va�qt.�llU l�fSu� �`1zr�aa3 .o64z <br /> CONTRACTOR � AODRESS ZIP CONTR.UCENSE 1 <br /> PHONE <br /> PROPOSED USE OF BUILDING f� Building � Mechenical Addilion HEAT SOURCE <br /> ,n PEHMIT �� Combinalion Plumbing WORK Alteratbn R Elaclrlc <br /> S F ' ` TYPE K Demolllion Sign . TYPE New �.,,j Oes <br /> L1 Sprinklet RepeldMalnl. U Olher <br /> � CONTAACT PRICE OF WORK � � � /.��Q � - � - -' ��CIT11 OF EVERETT LOCAL SALES TAX CODE IS 9106 <br /> <� <br /> WORK OESCRIPTION <br /> ' PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FlXTURE OR REM <br /> WATEA CLOSET A/C–A/HANDLINO UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATEFS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANOE HOOD <br /> LAUNDRY TRAY WATER HEAT[R <br /> CLOTHES WASHER � METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN OAS RANOE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERiI"IFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PqOVI510NS OF LAWS f.ND ORIDIN.ACES GOVERNING THIS TYPE OF WORK WILL BE COMPl1ED WITN WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GR�NTING OF A PERMIT OOES NOT PRESUME TO 61VE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAI LAW FEGULATING;:ONSTRUCTION OR 7HE 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 /> :ONTRACTORS LAW iB27 RCW AND 296.200 WAC. <br /> Signalure ol Owner/Conlractor/Authorized Agent ate //Q —D ! 7 <br />