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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 ADQRESS PARCEL TAX I.D,N p��t p � <br /> ya:3 �.�,•a C�.,� �.�. ��.� �✓�r�t{ � "� 05 �C,� <br /> LE LOTNO. BLOCK TRACT <br /> DESC. <br /> OYYNER ADORESS ZIP PMONE <br /> /'�1 ,�� 7 �G '/ <br /> ��/�kG� � U�5 ��-? iLfr;(e�la LL�oy `L� CG'CI'Grf� e�.'� %.�'S-S/��7-9✓�c/ <br /> TENANT NMIE I CONTACT R PERMIT � PHONE <br /> /I.�/A <br /> CONTRACTOR ��/� ADDRESS ZIP CONTR.LICENSE• <br /> v <br /> PHONE <br /> PROPOSED USE OF BUILDING 8uilding MechaniCel Addition HEAT SOURCE <br /> PERMIi B Combination � Plumbirg IWORN �teation I � Eleanc <br /> iYPE D Demolition Sign TYPE New Gas <br /> �Ci 5 w4/ i�y,�It�i��>L, U Sprinkler epairlMaint. Othar <br /> COHiHACT PRICE OF WORK CITV OF EVEREiT LOCAL SALES TA%CODE IS 1105 <br /> WORK DFSCRIPTON <br /> I\��Jlv,'C�, /1-}.;��,t �iJa�e;- �,ii�, -��;..�, Gi'�tij �Li�..:� -or'(� (/alc�c_. L� Sireo�{� <br /> C'��'�e -� „ ficu$e,. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXNRE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> _ WATERCLOSET AIC-AIHANDLINGUNITS <br /> _ BATHTUB FORCEDAIRSYSTEMS <br /> _ LAVATORY(WASH BASIN) HEATPUMP <br /> _ SHOWER UNITHEATERS <br /> _ KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY WqTER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACEISTOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR ORAIN GAS hiWit+•3E <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICEIBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ 4ND EYAMINED THI5,4PPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINAC[S GOVCRNING T1iIS TYPE OP WORN WILL BE COMPLIED WITH WHETHER SPEpFIED HEREIN OR <br /> NOT. TI1E GRANTING OF A PERMIT DO[5 NOT PRESl1ME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY 07HER <br /> STATE OR LOC�L LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONStRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM IiF WORK FOR WNICH APPLICATIGN IS MADE AND I COMPLY WI7H THE STATE <br /> CONTRACTORS LAW 1827 RCW A .200 Wq . <br /> `��-` � �-�-L �—�• ) j-�_� <br /> Signalureo OwnedContrador ➢tlronzed�,4genl-- Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />