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--� - i <br /> PE�RMIT APPLICATION '� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-8810- FAX 475-257-8857 <br /> SI E DRE S PARCEL TAX I.D.# �� PERMi7 x <br /> � �'��2���Z /50�/�.� - D �� i <br /> LEGAL lOiNO. BIOCK TRACT I <br /> DESC. i <br /> OWNER ADDRE55 ZIP PHONE <br /> � �h�"�� � �� ��- '��f c���bh� �l� �°����� <br /> TENANTNAME CONTACTFOR PERMIT PHONE <br /> �r`�� �1��-c� G• ct�-��-.'�C���g�R� <br /> CONI�•.ACTOR��� �. ADORESS� I�oit/.,�� ZIP CONTR.LI�SE# <br /> (VJ o. / �d �rJ <br /> Y>•+ W <br /> PHONE <br /> PROPOSEO USE OF BUILOING ��o,'—�`'uilding I� Mechanical Ad�ition HEAT SOURCE <br /> PERMIT I ) Gombination K Plumbing WORK � Alleration � Electnc <br /> n � TYPE H Demolition U Sign IYPE New Gas <br /> I��� LJ Sp�inkler RepaivA7aint Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION � ��/_ -_ - L <br /> �l, " � ��C�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIX'iJRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �NATER CLOSET(TOILET) A/C—AIHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVNTORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> I _ LAUNDpY TRAY _ WATER HEATER <br /> CLC�HES vvi,3HER METAL =1REPLACElSTOVE <br /> URINAL FIREPLACE INSERT <br /> '. DRIfJKING FOUNTAIN GAS FIREPIACE <br /> � FLGOR DRAIN _ GAS RANGE <br /> �� BACKF�_OW PREVENTER GAS PIPING <br /> ��, SINK(SERVICEiBAR/MOPIETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY JERITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL I <br /> PROVISIONS OF LFWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED NEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DO NOT PRESU�fE TO GIVE AUTHGRIN TO VIOWTE OR CANCEL THE Pft0.''SION OF AI�Y OTHER � <br /> STATE OF. l0 AL AW REG TING TRUCTION OR THE FERFORMANCE OF CONSTRUCTION. THAT I Ah1 AUTHORIZED BY THE I <br /> OWNER F IS. R TC PER .1 THE WORK FOR 1YHICH APPLICATIO IS MADE AND I COh1PLY WITH THE STATE <br /> CONT , A 27 A 200 WAC. _ /��� I <br /> / � � I <br /> Sig ature of OwneuContrac;or�A thorized Agent Date ,��i ' <br /> I <br /> DEBiT 8 CREDI'i CARDS ARE NOT ACCEPTED � <br />