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• <br /> � PERMIT APPLICAI ION <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.# PERMIT# <br /> ��fj.C� (.('/��hbx-G e /v� ���� �U� � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS ZIP PHONE <br /> 5f�vc�, �c� ��/LO Cr/e f�n�.-e .�i,�c �-u�i� 98zv/ '/zS-��''S— ,53'7z <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> CONTRACTO/R ADDRE53 y�- q� ZIP CONf/TR.L�IJCENSE M <br /> ��hAtr .���5 l� .�t'.-u'cc .Zn c p���X /'�/L,' .CG(!// / vyU6 L�/.�i7�.s.5 O�Q'L/ <br /> PHONE <br /> ;�zti-z.>9� Z/l/ <br /> PROPOSED USE OF BUILDING f� Building 6d Mechan(cal Addition HEAT SOURCE <br /> PERMIT K Combination FI--{('Plumbing WORK Alteration trF-t�Electnc <br /> TYPE �__� Demolition LJ Sign TYPE New �._j Gas <br /> /�P5 u Sprinkler Repair/Main4 L� Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORK DESCRIPTION <br /> .-�,s f // /S��f r�,du,.�p <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OP 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 /> LAUNDRY TRAY _ WATER HEA'�'ER <br /> CLOTHES WASHER _ METAL FIREPLACEISTOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPIACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BARfMOP/ETC.) __ EXHAUST FAN <br /> OTHER __ OTHER <br /> I HEREBY CERITIFY THAT I HAVC- READ AND EXAAIINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL�E COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THG GRANTING OF A PERMIT DO`cS NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHE� <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWN OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CON ACTORS LAW 18.27 RCW AND 296.200 WA <br /> � .� � { �z��d� <br /> Sign re of OwnedContrector/Au ionzed Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />