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PERMIT APPLICATIOr� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-881(1 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMiT x <br /> l7Z1 �2UU�� ob K3�O 3'f S ol0 00 �5 �� -DO� <br /> LEGA LOTNO. BLOCK TRACT <br /> oesc. �v— 11 `-I �� • A (v. (� �l.w-r dF <br /> OWNER ADORESS ZIP PNONE <br /> slMtli l�.w� c 1 z( Rc�cc<;�2 �� 9ez�o� z sTr-�z�-o <br /> TENANTNAME CONTAC�FORPERMIT PHONE <br /> CONTRACTOR D,��0���� ADDRESS ZIP CONTR.LICENSE II <br /> I�ox i�q�t DR'tDr�co`zNs <br /> PHONE 2$(-7ZS� '�U�i�+ tl.1.� • Q��CNo _�KP 6-30-04 <br /> PROPOSED USE OF BUILDING I � Building D Mechanical Addition HEAT SOURCE <br /> PERMIT Combination U Plumbing WORK R /Uleration � Eleclnc <br /> �i-�(Zl�try� 7YpE Deinolition U s�9n TYPE [� New Gas <br /> Sprinkler U RepairlMaint. Other <br /> CONTRACT PRICE OF WORK � c�`«� CITY OF EYERETT LOCAL SALES TA%CODE IS�105 <br /> WORKDESCRIPTION G6��R��`O�` O� � ZG�`�Z.�o � (�'FFT�GkFt'-� C's(�6Ft <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF 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 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRYTRAY _ WATERHEATER <br /> CLOTHES WASHER METAL 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 I <br /> I — _ _ i <br /> I HERE�Y CERITIFV THAT 1 HAVE READ AND EXP.M1IINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br /> PROVISIONS OF U1W5 AND ORIDINACES GOVERNING THIS iYPE OF WORK WILL BE COAIPLIED 1NITH WHETHER SPECIFIED HEREIN OR � <br /> ' NOT. THE GRANTING JF A PERMIT DOES NOT FRESUtdE TO GIVE AUTHORITI'TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER I <br /> � STATE OR LOCAL LA4V REGULATW(i CONSTnUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM'HE',VORK FOR N'HICH APPLICATION IS M11ADE AND I COMPLY WITH TME STATE I <br /> II CONTRACTORS LAW 7827 RCW AND 296.200 WAC. I <br /> iSignature of OwnedConiracrodAuthonzed Agent Date �/Z I <br /> j DEBIT& CREDIT CARDS ARE NOT ACCEPTED I <br />