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FERMIT APPLICATIc)N <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.# PERMIT z <br /> "17(� � l, r�� c� ,�0308-c�� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWN R ^ l ADDRESS ZIP PHONE <br /> � lv � � i°O,QaX 17.3� Cv�, �-�f �vl' 9��0� S� .�' <br /> �c v��,� r e�� t,- , � s �=-�3.�� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> i � I � I {" I � � <br /> ��vntlG.— <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE p <br /> PHONE <br /> PROPOSED USE OF BUILDING I ryPEIT B Spnnklleon�n � Sig�hbingal TMPEK B Repair/Maint. HEAT SGeRN` <br /> LJ Olher <br /> CONTRACT PRICE OF WORK CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTIOP{_� 'QGe e x1 JLi� '�i �j yt -�-h c �t O�l3 e �?<< �`/°t l�<�r <br /> ��r lcY< �lir�o��n u` �c�n ks -Fa b� IPm�c�rlPd Ic+t�r <br /> -)-1,c <br /> ) 1✓:JH/ll I Ol.l� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE 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 /> / �c KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> j x DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY I � WATcR HEATER <br /> / x CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLCOR DRAIN GAS RANGE <br /> BACKFLOW FREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOPIETC.) EXHAUST FAN <br /> OTHER OTHER <br /> .�. � > >�'`��'� — <br /> � <br /> i <br /> I HEREBY CERITIFY THAT I HAVE READ AN�EXAMWED THIS APPLICATION AND KNOW THE SAME TO 9E TRUE AND CORRECT. ALL <br /> i PROVISIONS O°IAWS AND ORIDINACES GOVERNING THIS T1PE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERM1IIT DOES NOT PRESUI+IE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHE� <br /> STATE OR LOCAL LAW REGULATING CONSTkUCTICN OR THE PERFORMANCE OF CONSTRUCTION. l'HAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK rOR WHICH APPLICATION IS MADE AND I COA4PLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. � <br /> Gi ' �J� -cL'3 <br /> Signat6re of Ow uC tf crorlAuthorized Agent Date <br /> DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />