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� <br /> { � r <br /> PERMIT 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.# PERhtIT# <br /> �Y3o l l�- / r��.— "`°�' -�s� <br /> LEGAL LOTNO. BLOCK TR^.T <br /> DESC <br /> OWNER / � ADDRESS ZIP PHONE <br /> ����v rvl l l � (2 �0 2.._ �vr,�t �fi �� �o� �l�� 4�Zz 2.� z <br /> � �� I o Qo� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �0��� •� S� 0 Z FZ <br /> CONT ACTOR . J �� ADDRESS l�� p ��„U ���u��ZIP CONTR.LICENSE# <br /> ^ ��-`o� <br /> PHONE ,�sq - �r � �y� Jff(/eS ��S�� Ll�tii <br /> `� z S- �-�' � - <br /> PROPOSED USE OF BUILDING I7 BUlld'Ing D MeChaniCal Q Addillon IIEAT SOURCE <br /> PERMIT �_� Combination U Plumbing WORK � Alteration �Clectnc <br /> TYPE �( Demolition U Sign IYPE New Gas <br /> (2�, - 5 F � �� Sprinkler RepaidMaim. Other <br /> CONTRACT PRICE OF WORK _II/��� CIN OF EVERETT LOCAL SALES TAX COUE IS]105 <br /> V' <br /> WORK DESCRIPTION � <br /> �H ���Gr ��+s L � <�r � �Ks�_- _ <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 _ UNITHEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDR'(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/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER_ <br /> '� I HEREBY CERITIFY THAT I hiAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL <br /> i PRUVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPEGFIED HEREIN OR <br /> i NOT. THE GRANTING OF A PERM1IIT DOES NOT PRESUM11E TO GIVE AU i HORIN TO VIOLATE OR CANCEL TFiE PROVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM HUTHORIZED BY THE <br /> OWNER OF 7HIS PJ20PERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS WADE AND I COMPLY WITH THE STAT'e <br /> CONTRACTORS L�P.W 18.27 RCW AND 29G.200 WAC. <br /> � ,�3���✓ <br /> ��G�� I� „��� , <br /> Signature of Owner/ContractorAuthonzed Agent Dale ��U�� I — 0S7 <br /> DE31T 8 CREDIT CARDS ARE NOT ACCEPTEQ � <br />