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� P RMIT APPLICATI�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 TAX I.D.# P MI7 p <br /> �/ 2U 7sr3ya � a oo I�at�o� - vc� <br /> LEGAL LOT N0. O K TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE � <br /> � /1(p�'SQ �J Fa�, v / �2 �-1���1:� 7/ <br /> I l � � 3 S D .3 . ?� l .cJl,t� <br /> TENANT NAME—��� CONTACT FOR PERM�T PHONE <br /> � �'R�;� w�rT yZs� Z3F�3?(al-- <br /> CONTRACTOR AOD� IP CONTR.LICENSE N <br /> �, u>.� s7"c'o�T���T,�v �s�J� �+�Ps�c ossJ <br /> PHONE _ 2 . �� Z O 7 7 ST61 IP�/ 7 I <br /> PROPOSEO USE OF BUILDING BPilding fl Mechanical I AddPition I HEAT SOURCE <br /> PERMIT �Combination H Plumbing WORK R AlteraUon � Elechic <br /> (� �/,pk � TYPE Demolition LJ Sign TYNE D New Gas <br /> S rinkler U Re air Naint. Other <br /> CONTRACT PRICE OF WORK CITY Of EVERETT LOCAL SALES TIU(CODE IS 9105 <br /> WORK DESCRIPTION <br /> (� � F�O . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTIIRE OR ITEI.1 NO. TYPE OF FIXNRE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB �ORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACEISTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOPlFTC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT i HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TftUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND OlilOiNACES GOVERNING THIS TYPE OF WORK WILL BF.COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL TFiE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRI.CTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THF <br /> Ol'JNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITN THE STATE <br /> CONTRACTORS LAW 78.27 RCW AND 296200 WAC. <br /> � v '� . ; Ga� 2/- C�S� <br /> Signatur �eNContractodAuthonzed Agenl Date ! <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />