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, - <br /> �� PERMIT APPLICA�� ION <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.M ( �Q PERMIT# <br /> �� 3� ,�o .��'.� r(-�� C ;M�� �Q,y�.o�� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. ��(� <br /> OWNER ADURESS ZIP PHONE <br /> � �IM ��tv�t�"e/��fSr9�Qr� <br /> TENANT NAME CONT T FOR PERh11T PHONE <br /> � ,QC�N� L �Sr 4t'1 S�t r-{a �� �zS z�z -SS SZ <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSEN <br /> PHONE �fL� <br /> PROPOSEU USE OF BUILDING Building I� MechaniCal Addition HEAT SOURCE <br /> PERMIT �COmbination �_� Plumbing WORK B Alleration � Electric <br /> TYPE Dem0litiOn LJ Sign T'PE ❑ New Gas <br /> Sprinkler U RepaidMaint Olher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION • ' <br /> ���-�--� I Z >C � rj'�-e rd M �9 3 f 1-0��t TF .� N <br /> ����� ��2��o{' r "7y L-iNe, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXNRE 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 CL�THES DRYER <br /> DISHWASHER RANGE F'OOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOPIETC.) EXHAUST FAN <br /> OTHER _ QTHER <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 COMPL'ED�VITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE GR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAbV 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 /> CONTRACTORS LAW�9.27�Fj�CW AND 296.2001NAC. <br /> /" �hu�M�('t ^,�Wl��� ' `"� �L J (/ J <br /> Sj nature of OwnedContract Authorized Agent Date <br /> � DEBiT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> i <br />