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1 ' <br /> P�RMIT 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 I PARCEL TAX I.D.# PERMi7 tt <br /> i 7 o v Ra�f-e Fci/�l� SC�4o3 -oQ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> l�rl�,v�� 8/'�wu yn�2 S�r<Ne w�•�y (�uuu.� w� yfla�7 7y393 �S <br /> TENAN7NAME CONTACTFORPERMIT PHONE <br /> [ d,vn. �'arrtT <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE N � <br /> SeC F <br /> PHONE <br /> PROPOSED USE OF BUILDING 67� Building Mechanical fl AddiUon HEAT SOURCE <br /> / PERMIT �_� Combinalion Plumbing WORK � � AlteraUon � Electric <br /> (�.p� TYPE �j Demolition Sign TYPE �_j New Gas <br /> L.) Sprinkler 1� Repair/Mainl. Other <br /> CONTRACT PRICE OF WORK / � �n G C CITY OP EVERETT LOCAL SALES TAX CODE IS J105 <br /> WORKDESCRIPTION ���L�f 5;G(�%'y fo �X�-�l'��al�� cy9r�d� � k�p��ce G✓�l� dW <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C—AIHANDLING UNiTS I <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 3 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREFLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS R,4NGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> '� i HERE�Y CERITIFY THAT I HAVE READ AND EXAM1IINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS T'PE OF VJORK�VILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> I NOT. THE GRANTING OP A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CAN(.�L 7HE PROVISION OF ANY OTHER I <br /> �� STATE OR LOCAL WW REGUWTING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. 7HAT I AM AU?HORIZED BY THE I <br /> iOWNER OF THIS PROPERTY TG PERFORM THE WORK FOR N'HICH APPLICATION IS MADE AND I COh1PLY WITH THE STATE <br /> CONTRACTORS LAW iB.27 RCW AND 296200 WAC. I <br /> F{-�� ?� ��� 3 - z-�y i <br /> Signature of Owner/ContractorlAuthonzetl Agent Date <br /> DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />