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I NERMIT APPLICAI`�ON <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.# PERMIT# <br /> / .�� rnaP�E rr Mo3ra-ca2-� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PNONE <br /> {�.n � Vi��c � /��C , niA�s� S! 98.�i �arS 3oa -66e i <br /> TENANT NM7E CONTACT FOR PERMIT PHONE <br /> SA.n^F .:l A+Jn✓E <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> S�„�� �,s A•3evc <br /> PHONE <br /> PROPOSED USE OF BUILDING Building fl MBchaniCal Addition HEAT SOURCE <br /> PERhvIT � Combinalion F� Plumbing WORK � FUteration � Electnc <br /> TYPF Demolilion �, Sign TYPE New Gas <br /> Sprinklef RepalrlMaint. Olher <br /> CONTRACT PRICE OF WORK ��S� CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION �,,�,r7;�LL G AS L�uCr Yon ti^ £'1- N6ATE'��Co•�vG-'" Ta (:.as Qn�yg� w <br /> /1l 'L+ hc�e c. /'�6.iTF... <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 /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACEISTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING�OUNTAIN GAS FIREPIACE <br /> FLOOR DRAW GAS RANGE <br /> BACKFLOW PREVENTER � GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETCJ EXHAUST FAN <br /> ;t OTHER /�.+rcti NEe;c2 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 TFIE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION 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 /> CONTRACTpRS LAW 1827�296.200 WAC. <br /> / 1 /et �/S-o� <br /> Signature of OwnedContractodAuthonzed Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />