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ERMIT APPLICAT�UN <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 /> a���.. 1.���.,�� � mc�3o9-oofv <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AOURESS ZIP PHONE <br /> ( y�Y.� Qe �.:.�C �1!•�2 C.J�k �r...�.-r �y� � rr_lT ciR201 �Z�•7S2 ' � 87(0 <br /> TENANT NAME I CONTACT FOR PERMIT PMONE <br /> CONTRACTOR ADURESS ZIP CONTR.LICENSE R <br /> K0.��y �+�at;�� <br /> PHONE �'roaG' W �+'KoeJ�r.) �-� D(' L <br /> 3Coo• S��j•O��Z S-v�chow, �� wn 98Zic� kH w�E �f� o�� Pfl <br /> PROPOSED USE OF BUILDING fl Building 17lMechanical I Additlon HEA7 SOURCE <br /> PERMIT K Combination H Plumbing WORK � Alleratlon I7 Eiectric <br /> TYPE �_� Demolition V Sign TYPE New �`��Gas <br /> I Ll Sprinkler Repair/Maint. t Other <br /> CONTRACT PRICE OF WORK �5� .,� C�TY OF EVERETT LOGLL SALES TAX CODE IS 1105 <br /> WORK DESCFiIPT10N � <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 _ UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE'STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/A40P/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> — _ � ��S w�_t� k..t-� <br /> I HEREBY CERITIFV THAT I HAVE REAG AND EXAMINED THIS APPIICATION 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 VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPI_ICATION I�MADE AND I COMPLY�YITH THE STATE <br /> CONTRACTORS LAVJ 1827 RCW AND 296.200 WAC. <br /> �1 ` Q,,LL�, 9 •4•c3 <br /> Sig�u e of OwnedContractor/ onzed Agent Gate <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />