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, <br /> PEt�MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES ���j-rJ� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 �� <br /> SITE ADDRESASn Z�2 9� 5T ,4D,�O! 3 _ �00 5 MIT a � <br /> .z�'��- !"lCc e. S�('. L�� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 ZIP PHONE <br /> �a�<<�.! 5 _ �o� ��,.� 9�zot ��a5)�52- �a5ti <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTOR AODRESS ZIP CONTR.LICENSE# <br /> 3�PNONE <br /> PROPOSED USE OF BUILDING Building I� MechaniCal Addition HEAT SOUkCE <br /> PERMIT � Combination �_� PlUmbing WORK � Alteration � ElecUic <br /> TYPE Demolilion LJ Sign IYPE New Gas <br /> Sprinkler RepaiUMaint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> WORK DESCRIPTION � QdCLt—�Q-� ...��lW �JI�C CUL`N`-� (�-� <br /> J <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Z WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> / BATHTUB � FORCED AIR SYSTEMS <br /> ? LAVATORY(WASH BASIN) HEAT PUMP <br /> /� SHOWrR UNITHEATERS <br /> � KITCHEN SINK& DISPOSAL T CLOTHES DRYER <br /> � DISHWASHER � RANGE HOOD <br /> � LAUNDRYTRAY / WATER HFATER <br /> ( CLOTHES WASHER � METAL FIREPLACE/STOVE ' <br /> b URINAL FIREPLACE INSERT <br /> c� DRINKING FOUNTAIN �— GAS RANGE CE <br /> FLOOR DRAIN <br /> � BACKFLOW PREVENTER / GAS PIPiNG <br /> c SINK(SERVICE/BAR/MOP/ETC.) 3� EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAh1INED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AN�ORIDINACES GOVERNING THIS 7YPE OF 1M1'ORK WILL BE COMPLIED WITN WHETHER SPECIFIED HEREIN OR I <br /> NOT. THE GR ING OP A PE 1�T DOES N0T PRESUAIE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER � <br /> STATE OR CA L1lN RE'U ING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED B1'THE <br /> OWNER O THI PROPERT ' PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRA R V AND 256200\NAC. <br /> ; (/ " , " O�'-I� -nb. <br /> Signat f Owner/ContractodAuthorized Agent Dale � <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED � I <br />