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P�RMIT APPLICATIO�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS /' 1 .}- PARCEL TAX�.D.# PERMIT# <br /> ���(� l�l/Pi 1YYt0('Qi M04o'� -o�to <br /> IEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> /�la�,a �C� 1�b�1 I�IIO l�e-I�o�e qgao� yaS-aS`�-a�a� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��c��,� K�.l�,� I <br /> CONTRACTOR AODRESS ZIP CONTR.LICENSE# <br /> SU19�tCQ, �NQMN �tN'�(�ej <br /> PHONE <br /> w � 6aa-S VJ"lci�n S'�'. 9 80l I <br /> l -�'00- S$� - 1045 E501'I�.il, �1v4 <br /> PROPOSED USE OF BUILDING I �PE�T R DPm kll a non U S'9n b ngal �E B Repa rlMaint, HEAT SGeR�CIE <br /> B � V Other <br /> CONTRACT PRICE OF WORK � �3 3'� � ' CITY OF EVERETT LOCAL SALES TA7C CODE IS 3105 <br /> WORK DESCRIPTION <br /> �� ✓I S�l 2 � � V1 c��l�r� � Ic �S t�'�re,���c� �i � S e� I <br /> �J <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 UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAI.FIREPLACE/STOVE <br /> URINAL � FIREPLACE INSERT J ^ � <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFV THAT I HAVE READ AND EXAA1INED THIS APPLICATION ANii KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED'�NITH WHETMER SPEGFIED HEREIN OR <br /> I NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORAI THE WORK FOR\VHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> I CONTRACiORS LAW 1827 RCW ND 296'00 WAC. <br /> ,A' C C-�lt.t,« ✓� CL�L'L�—\ 3- /v` - (i`� <br /> ' /S�naWre of OwneNContractodAuthonzed Agent Date <br /> � y I <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />