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P�RMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> . 425-257-8810- FAX 425-257-8857 <br /> v�� -t� ��r�,� c� �o� 9,�z a i <br /> SITE AODRESS PARCEL TAX I.D.� PERMIT# <br /> �Yl D3 D�?'-0o2-) <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> Y 1�� GL1 . �( t� �� !�at 1� � � z t=�.�,.,e'f�- 9 �Zo� Yzs Y�z z3s <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADURE55 ZIP CONTR.LICENSE# <br /> PHONE Se / I ' ` <br /> I t� <br /> PROPOSED USE OF BUIL�ING BPilding D Mechanical I AdPition I HEAT SOURCE <br /> PERMIT R Combinalion U Plumbing WORK � Alteretion �Electnc <br /> C Ue ✓t • TYPE D Demolilion U Sign TYPE New Gas <br /> u 5 rinkler Re aidMainL Other <br /> CONTRACT PRICE OF WORK � � CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> WORK DESCRIPTION • <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO.. TYPE OF FI%TURE OR IiEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT?UMF <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> C�CTHES WASHER METAL FIREPLACE/STOVE <br /> URIIJAL FIREPLACE INSERT <br /> DRI�IKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS P�PING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANL�KNOW THE SAME'f0 BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL dE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NO'. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTfiORIN TO VIOLATE OR CANCEL TI1E PROVISION OF ANY OTHER <br /> ST4it OP i3OCAL LAYJ 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 MAOE AND I COMPLY WITH THE STATE <br /> CONTR CjORS LAW 18.27 RCW A4D 296200 WAC. <br /> T,� c�..� �/� /� — <br /> Signature of Owner/Contracror/Authorized Agent Dato <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />