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� PEr2MIT APPLICATIOi� <br /> CITY OF EVERETT PE�MIT SERVICES <br /> 3200 CEDAR S i REET, EVERETT, WA 98201 I <br /> 425-257-8810- FAX 425-25%-885� `/�L� l I b / _� ) j <br /> �T t� X <br /> _ - � <br /> SITE ADDRESS I P/1RCEL TAX I.D.# � /PE�Rht,T z 1 i <br /> ZSIU .� �. _f�=�� C1C>�4 �(�Ci C:CC=- Jti�l' � l.�`l �'L VG`1_ I <br /> LEGAL LOT NO. BLO(:� TRACT I <br /> DES0. 5 S�-O�."O "� <br /> OWN:R ADDRESS ZIP PHONE <br /> c�o�.�2Et��.- tsn..s Lllr l'Io32.-3s�i�ue $L t�`�91� q��1?� �7�s't�3 <br /> TENANTNAME CONTACTFORPERMIT PHONE tll� <br /> � �._�w��..�S.S�Fi' �arJ - 1��-�� �g <br /> CONTRACTOR FDORESS ZIP CONTR.LICFNSE# <br /> �-c�a�R. C�,-4e.i(Jius�.�� ��-c- �'to�a-3s��u�SE 6oih� 95p��- ADf�s.e�ws��� <br /> PHONE <br /> PROPOSED USE OF BUILDING �'BU�Iding rLa7��,��echanical �tlilion HEAT SOURCE <br /> S`,n�`,� �,�,�,�'Iy PERMIT Combination ;�'F'lumbing WORK Aleration I� Electric <br /> �� IYPE Dem01iti0n U Sign TYPE ew �I�-{'�=as I <br /> Sprinkler RepaidMaint. V Olher <br /> CONTRACT PRICE GF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> WORK DESCRIPTION <br /> tJ e� ����1�. -��_� -���' (3o.a�c� -z� 2,a39 <br /> . I <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> '� WATER CLOSET(TOILET) A/C-PJHANDLING UNITS <br /> �_ BATHTUB _L FORCED AIR SYSTEMS � <br /> � LAVATORI'(WASH BASIN) _ HEAT PUM11P <br /> � SHOWER UNITHEATERS <br /> � KITCHEN SINK�DiSPOSAL �_ CLOTHES DRYER <br /> �_ DISHWASHER P,ANGE HOOD <br /> LAUNDRYTRAY �_ WATERHEATER <br /> � CIOTHES WASHeF _ METAL FIREPLACE/STOVE <br /> � _ 'JRINAL FIRFPLACE INSERT <br /> � _ DRWKING FOUNTAIN _j_ GAS FIREPLACE <br /> . _ FLOOR DRAIN � GAS RANGE <br /> BACKFLON'PREVcNTER GAS PIPING <br /> SINK(SERVICEiBAR/MOP/E'C.) j EXHAUST FAN <br /> OTHER OTHER <br /> I I HEREBY CERITIFY THAT I HAVE READ AND EXAMINEC TYIS APPLiCAT10N AND KNOW THE-SAI.!E�i O BE TRUE AND CORRECT. ALL <br /> ' PROVISIONS OF LAWS AND O�IDINACES GOVERNING THIS i YPE OF WORK\YILL BE COk.PUEO WITH 1VHE�hER SPECIFIED HEREIN OR � <br /> � NOT. THE GRANTING Or A PERPdiT DOES NOT PRESUAIE TO GIVE dUTHORITY TO\'IOL�i�OR CANCEL THE PROVISION OF AN1'OTNER <br /> STATE OR LOCAL U1W REGUUITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> I OWNER OF THIS PROPERTY TO PERFORP.1 Ti!E'.NORK FOR 1VHICH APPLICATION IS 6fADE AND I COMPLY WITH THE STATE <br /> iCONT �CTORS L16V 1827 RCW AND 296200 WAC. ,I <br /> � ��. —!n l a��� �-y� � <br /> Signature o wneuContractouA h �zed Agent Date � , <br /> DEBIT & CREDIT CARUS ARE NOT ACCEPTED i <br />