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PERMIT APPLICATIO�N <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 7AX I.D.N PERMIT# <br /> /d>�� � �'�O�-Ua-� <br /> I�GA LOTNO. BLOCK TRACT <br /> VESC. <br /> OIVNER ADDRESS ZIP PHONE <br /> ���,v G✓r��/-r,� i�i� ��� .�-�y �✓-r�rff g.��d/ �5�. -iy�.6 <br /> T'.�L1NT NAME CONTACT FOR PERMIT PHONE <br /> o"ONTRACTOR ADDRESS�✓{�1 �,/�lS` ZiP,r�D�6!D UW <br /> ���y .�� Fo �ix�vyi �k� Y � „- � , <br /> �/>-s"-33 y ��r/d3 <br /> PROPOSED USE OF BUILDING pp� Building Mechanical Addition HEAT SOURCE <br /> PERMIT �.�(( Combinalion R�( Plumbing WORK Alteration ElecMc <br /> � q TYPE �j Demolition �,J Sign IYPE New � Gas <br /> � S���y,�L U Spnnkler Repair�Mainc Other <br /> CONTRACT PRICE OF WORK �y S,L � 7 5 5 U OG CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> 7 <br /> WORK DESCRIPTION <br /> /� Yvd� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C–AIHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOINER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CIOTHES DRY�R <br /> DISHINASHER RANGE HOO� <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER � METAL FIREPIACElSTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOPIETC.) EXHAUST FAN <br /> OTHER OTHER <br /> j — — - I <br /> i <br /> II I HErt"eGY CERITIFY THAT I HAVE READ AND E,`(AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PPG\9SIONS OF LAWS AND ORIDINACES C>OVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOl. THE GRANTING OF A PERNIT DOES VOT PRESUI.�E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRCVISION OF ANY OThIER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTFIORIZEO BY THE <br /> OWNER OF THIS PROPERTY TO PER�ORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ICON CTORS LAW 78 RC AN 296.200 WAC. <br /> � il�.n.� � n ✓ <br /> i <br /> ig u e of Own r/Contractor/Authonzed Agent Date <br /> I DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />