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PERMIT APPLICATION <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 It <br /> �,2�- /�vc. �Uf/G M�yo 3-o�oZ <br /> LEGA LOTNO. BLOCK TRACT <br /> �ESC. <br /> OWNER ADDRESS ZIP PMONE <br /> Sh�� �vo�'e, y5i�- i3i-�pi ,UE msul 9�a7i (3co)��-���6 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ' /�ort.� I cJh P.21 wo� '�{-e� SC� rY�, <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE k <br /> PHONE <br /> PROPOSED USE OF BUILDING Building f� Mechanical I Atldition I HEAT SOURCE <br /> I PERMIT Combinalion H Plumbing WORK RI--1 Alteralion Q ElecUic <br /> TYPE � Demolition V Sign TYFE �J New pq Gas <br /> Spnnkler U Repalr/Maint U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETf LOCAL SALES TAX CODE�S 3105 <br /> WO/R�K_`DE,SCRIPTION �� <br /> tt�.7C�rtG cLgQS -FvrnacA '�ti �}-�� �'i�.rt� <br /> J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. . TYPE OF FU(TURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BAS!N) HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HO00 <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPIACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR Df.AIN GAS RANGE <br /> BACKFLOW PREVENTER � GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TFIE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS OPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOR 7827 RCW AND 296. 00 WAC. / <br /> � , � ��/�/ <br /> SignaWre o(OwnedContracror/Auth nzed Agen' Date <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />