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P RMIT APPLICATIO�N <br /> C�7Y OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 Ii <br /> 425-257-8810- FAX 425-257-8857 <br /> 1�--�� `�� <br /> SITE ADDRESS PARCEL TAl(I.D.# PE�jMIT at <br /> � �� `-' �'. �--v -� -v9. <br /> « , � .:\� <br /> LEGA lOTNO. BLOCK TRACT <br /> D'cSC. <br /> OWNER ADDRESS ZIP PHONE <br /> .�� e�S '�l� � S.�_Q-� 5l/.��7 � J\G\1� 1�'✓� Lv.2�cL� � U L1� <br /> TENANT NAM=-,//� CONTACT FOR PERMI PHONE <br /> W <br /> �.J!-..c.S .r-1" - �1 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> PHONE �$ �y <br /> I_�Z5 ' ���1 ' (�_9 25f� � <br /> PROPOSED USE OF BUILDING � Q�uildi�g Mechanical Atldition HEAT SOURCE <br /> I PERMIT �_) Combinalion R Plumbing WORK R Alteratlon � Electnc <br /> TYPE D Demolition d Sign TYPE D New Gas <br /> � �1 t c...... <br /> U Sprinkler U RepaidMaint Other <br /> CONTR T PRICE OF WORK ,� � �, I CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCR�PTION <br /> T <br /> 51�.1Gj.� �F�M1�Y 12�S�J(r,N� <br /> ��a��� �:z��.. .�..:. � �,�� ��� <br /> PLUMBIN 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 PUA1P <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE h100D <br /> - LAUNDRl'l-RAY WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> I _ FLOOR DRAIN _ GAS kANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I — — <br /> � <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME i O BE TRUE AND CORRECT. AlL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYP�OF WORK WILL BE COMPLIED 1NITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT OOES NOT PRESUA7E TO GIVE AUTHORI?Y TO VIOLATE OR CANCEL THE PROVISIOY OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZE�6V THE <br /> - OWNER OF THIS PROPERTY TO PERFORAI THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> �, CONTRACTORS LAW 78.27RCW AND 296..00 WAC. <br /> � <br /> �, � 1 �Z'�Z' �� <br /> Signature'ot wn ior/Authonzed Agent Dale � <br /> � �z <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />