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P�RMIT APPLICATI�iN <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT,WA 98201 � <br /> 425-257-8810-FAX 425-257-8857 /�� �O� -D//_ � <br /> �� (�/ <br /> SITE APDRESS PARCEI TlU(I.D.N PERMiT M � <br /> . N� U` ��YI _/\iC <br /> LEGA l07 NO. BLOCK TRACT � /)C1-� " j—Q � <br /> � �+�- <br /> �ESC. <br /> OWNER D ESS ZIP PHONE <br /> (��i�v���c��s /�,yyE� �..�.-�,?._.29-lJ�rrfn�'�in -z�v,��rr 98Z0f-�f1.s-33�-9079 <br /> TE AN7 NAME COHiACT FOR PERMIT PHONE <br /> � �� -�,- <fe�S-�337- `70'79 <br /> CONTRACTOR ,5/�.�L /Qg Qq,),ur3� ADORESS ZIP CONTR.UCENSE� ' <br /> PHONE <br /> � <br /> PROPOSED USE OF BUILDING I Building fl Mechanical Addillon HEAT SOURCE <br /> PERMIT COmbinali0n H Piumbing WORK R�..j Alteralion R Eledric <br /> ��� TYPE Demo 7n V Slgn TYPE uQ New J�Q Gae ; <br /> Sprinkler l.J RepairlMaint. U ou,er <br /> i <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS J10S ! <br /> WORK DESCRIPTION <br /> � � �C_ <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 /> SHOWER UNIT HEATERS <br /> 1_ KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER ! <br /> I DISHWASHER � RANGE HOOD f <br /> LAUNDRYTRAY ,� WATER HEATER � <br /> _L CLOTHES WASHER _ METAL FIREPLACe/STOVE � <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE � <br /> FLOOR DRAIN GAS RANGE � <br /> BACKFLOW PREVENTER ,� GAS PIPING I <br /> SINK(SERVICEIBARlMOPIETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNIIJG THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERM�T UOES NOT PRESUIdE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> S7�TE OR LOC�L LAW REGULATING CONSTR�IC710N OR 7HE PERFORMANCE OF CONSTRUCTION. THAT I AM AUiHORIZEO BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM TFit WORK FOR WHICIi APPLICATION IS MADE AND 1 COh1PLY WITH TI1E STATE <br /> CONiRACT S LAW 18.27 RCW ANU 296.200 WAC. <br /> i <br /> 'I- � 03 <br /> Sig ure Owner Conlre d uthorized Agenl Dale <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED �Z <br />