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( <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 PARCEL TAX I.D.JF PERMIT p <br /> �yog �SrQ2 w �z-�� �,a�i oo�o �� o� C��a3 -�� <br /> IEGA� LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER /� N0.q ,7IC O� ✓�`y��'ur� '''f _ <br /> ADDRESS ZIP PHONE <br /> � Ron.� �l �, I ft <br /> l�ra�T�y�, c �ya8 / - �i�. ocJ 9dLo3 3 5 S-S�g y <br /> TENANi NAME CON7ACT FOR PERMIT PHONE <br /> � I R�,� G��»,�,,��K � 3.ss- sasy <br /> CONTRACTOR ADDRESS � ZIP CONTR.LICENSE 8 <br /> PHONE Q�1� 'e✓ <br /> PROPOSEU USE OF�UILDING I Building Mechanical AddWon HEATSOURCE <br /> PERMIT Combinalion R�( Plumbing YIQRK Alleration R ElecVic <br /> 7YPE � Demolition v Sign TYPE � New �.j Gas <br /> Sprinkler RepairlMaint. U Olher <br /> CONTRACT PRICE OF WORK /5�/�7/n0 CITY OF EVERETT LOCAL SALES TAX CODE IS]105 <br /> / <br /> WORK DESCRIPTION <br /> r� � � , �f.-o � a 3 � �9 !x ���,, �� y ,no,� <br /> PLUM8ING 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 /> _ SHOWER UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL CLOTHES�RYER <br /> _ DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> __ DRINKING FOUNTAIN T GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER � GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> __ OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNI�G THIS NPE OF WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CO�TRACTORS lAW 18. 1 RCW AND 296.200 WAC. <br /> I`�,�e�' \�i i A Q,�� 3�i Z�b 4� <br /> Signature of OwnedContracror�j�u{Ifonzed Agent Date � <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED 1I L <br />