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� i <br /> PtRMIT APPL ICATIvN <br /> CITY OF EVERETT PERIIAIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425�257-8810- FAX 425-25'-8857 <br /> SITE ADDRESS � ' PARCEL TAX I.D.# I PERMIT C <br /> �Sda� l� .��t � � c:t73�c3oo�ovs�v3 _; $ o3�G-��15 <br /> LEGAL LOTN0. � B OCK TRACT <br /> DFSC. <br /> OWNER ADDRESS ZIP PHO^!E <br /> ��r � �-, �1 i7 <br /> �GC�,is�� G�yJ. 5' •',e _S� U/n..�� �D/� <br /> TENANT NAME I CONTACT FOR PERMIT PHO'JE <br /> I <br /> CONTRACTOR A�DRESS ZIP CONTR.LICENSE# <br /> PHONE <br /> L /�--�/ <br /> PROPOSED USE OF BUILDING pERM1T � SPmbiln�ation U Plumbinlg�� WORK �—( RtlPa U��ainl, HEAT SE ecRtric <br /> TYPE Demolition U Sign TYPE �__� New Gas <br /> LJ Olher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> ����� �-- ��"'r'� �;�- gh°.-�pl�� /�'� - � � - �� <br /> , <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> SATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOYVER UNIT HEATERS <br /> ICITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACEINSERT <br /> i DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BARlMOPIETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFV THAT I HAVE READ AN�E.XAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF�VORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRAN-ING OF A PERMIT DOES NOT PRESUA�IE TO GIVE AUTHORIN TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL V1W REGULATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNEP OF THIS PROPERTY TO PERFORM THE�VORK FOR LVHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTR+CTORS LAW 1817 RCW AND 296.20u WAC. <br /> Signature ot OwnndContractor/Authonzed Agent Date � <br /> �_____ DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />