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PERMIT APPLICATI <br /> CITY OF EVERETT PERMIT SER'yICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> — 425-257-8810- FAX 425-257-8857 n 1 �O� _�O Si <br /> f� w <br /> SITE ADDRES:� PARCEL TAl( I.D.# P�tM1T#i„� _ O� �/ <br /> 31 Ui e � �v 7 �- `-�" `1 <br /> LEGAL LJTNO. BLOCIC TRACT �� � � <br /> �ES�. � .�8' y �� � / 2 3 9�' <br /> �G.A �y S �J�s�o/�N �,�'�c�. S�bl7 �CC'.Y/l�oc� l��` ��3"�y�S 3 S�3=iY'z�6 <br /> TENAN'�NA E � I CONTACT FOR PERMIT PHONE <br /> �'��-c <br /> COYTRACTOR � X C AODRESS ZIP CONTR.UCENSE q <br /> �J eSs�� c`��/ e t�ieca' 1 �U �� �-2 4 9 Jl�So�/D�'B <br /> FHONE y�� -.� v�-s�9� � CrSS���Y f'//i7' /0 ��(L_� <br /> PROPOSED USE OF BUILDiNG Ia-B uilding �rj-Me�.hanical ACCaion HEAT SOURCE <br /> I PERMI7 KI....( Combinalion F�'nlumbing IWORK R�( A�lteratlon I lectnc <br /> Q�/euy SF�' � TYPE u �emolition V Sgn TYPE �'Rew �as <br /> u Sprinkler U Repair/Maint. L� Olher <br /> CONTRACT PRICE OF WORK .� ���� CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> � � � <br /> WORK DESCRIPTION ' / <br /> �'Gn.�C,<� �ull j r o/i2- � <br /> �:�, � �� a ��� <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE 9F 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 UNITHEATERS <br /> '� KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> _L DISHWASHER RANGE HOOD <br /> LAUNORY TRAY WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREP'ACE INSERT <br /> DRINKING FOUNTAIN GA;;FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLO�V PREVENTeR GAS PIPING <br /> _ SINK(SERVIGE/BAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> 1 HEf..-.Y CERITIFY THAT I HAV[READ AND EXAPdINED THIS APPLICATION AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORI�INACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WI7H WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM1fE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF AN1'OTHER <br /> STATE OR LOCAL LA6V GULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR12ED BY THE <br /> 01NNER OF THIS PRO N TO PERFORM THE WORK FOR WHICH AP��ICATION IS MADE AND I COMPLY VJITH THE STATE <br /> CONTRACTO 6 LAW 7 RCW AND 296.2U0 WAC. <br /> ���� i-�1, ,�2 - �S <br /> Sign ure of /Ccntractor/ o d Agent uzte /7 I <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED �L/ <br />