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i i <br /> P�RMIT APRLICATION <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 /> �/ �� / � � �-�i <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> ��O�, <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> (sL�C�/',C �-QC /�C 1�� <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> PHONE � �1 C�ti ��`��, <br /> C� �.�.. -�, <br /> PROPOSED USE 0 BUILDING Building �chanical I I"") Addition HEAT SOURCE <br /> I PERMIT Combination Plumbing WORK K Alleration Electnc <br /> TYPE Demolition Sign 1YPE �__� New � Gas <br /> Sprinkler U Repair�'Mainl. 01her <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX:JDE IS 3105 <br /> WORK OESCRIPTION <br /> /�.(' CGvi��L� .-�.. f�✓��. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C-FVHANDLING 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 /> LAUNDRYTRAY 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/MOP/ETC.) _ EXHAUST FAN -� <br /> OTHER _ OTHER � TK�N ' O��S <br /> — a.�d cu r.Tv', N s"s�.s <br /> II HEREBY CERITIFY THAT I HAVE READ AND EXAA1INED 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 COA7PLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh1E TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW R ULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM17 AUTHORIZED BY THE <br /> OWNER O�THIS PRO RFORM THE WORK FOR WNICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CON .R TO j(iCW AND 296.200 WAC. <br /> ,�� � � - � oy <br /> ignatur of OWner/ContractodAuthonzed Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED ; <br />