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PtRMIT APPLICATIUrN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# =RMI7# <br /> izo8 l7uckc-�e Av� zXZ <br /> LEGA LOTNO. BLUCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> 12���! 5���fe� izo$ i�u���e � 951�� �{as 25q-9z�q <br /> TENANT N E CONTACT FOR PERMIT PHONE <br /> �fl �,�� '`Tw �iJo� I � �„���� yzs Zs7-b"1'�r <br /> CONTRACTOR ADDRE53 21P CONTR.LICENSE N <br /> PHONE <br /> PROPOSED USE OF BUILDING Building I""1 Mechanical Additlon NEAT SOURCE <br /> ���(;(.� �AMIL`� PERMIT Combination K Plumbing WORK Alte2tion ElecUic <br /> TYPE � Demolition IJ Sign iYPE � New �R—( Gas <br /> -.Qjyt�( ��CjI�PnGL U Sprinkler RepairlMainL LJ Other <br /> CONTRACT PRICE OP WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> WORK DESCRIPTION <br /> ���1L'7.1� �IvIGWr/� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO.. 1YPE OF FI%TURE OR ITEM <br /> � WATERCLOSET(TOILET) AiC—A/HANDLINGUNITS <br /> � BATHTUB FURCED AIR SYSTEMS <br /> J_ LAVATORY(WASH BASIN) H1=AT PUMP <br /> � SHOWER UNITHEATERS <br /> KITCHEN SINK&D�SPOSAL CI.OTHES DRYER <br /> DISHWASHER Rl1NGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER ML"TAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> � SINK(SERVICE/BAR/MOPlETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE PERFORMANC'c OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW iB27 RCW AND 296.200 WAC. <br /> Signature o(Owner/ContracrorlAuthorized Agent Date � <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> �% <br />