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PERMIT APPLICATIOiV <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.# P <br /> � �/(,c�� JrT G.tJ UQ �/�1SDOo I 0 � 7 -0�-� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS ZIP PHONE <br /> r;� c��c.:r y „?4;�:,;,,,�,� �� _ y6 -t� 5-,- S �.J �ao 3 �> s� � S 2 � � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> i'���� Y1k�y,��.�- I ,��� /ZsaYuprZ ��1 s�� V� 1 �GG6 S' <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> PHONE <br /> PRUPOSED USE OF BUILOING pERM1T I'( Spr nklleati0n U Si9n b�9a1 NpE B Reps ilMainl, HEA�T7,SGaRtCE <br /> TYPE H Demalition U IJ O�her <br /> �J LJ <br /> CONTP.ACT PRICE OF WORK /O �` �<� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> �. � . <br /> ,�; t:�� i (;} �'` i>!> t;,1, 1 f� I (sap��l/1.{��A.�,,. <br /> �53 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVPTORY(WASH BASIN) HEAT PUMP <br /> SHOWER �l UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPIFlCE/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 <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLi;:�"ION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE GF':YORK W�LL BE COh1PLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE IiRANTING OF A PERMIT DOES NOT PRESUME TO GIVE F'JTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERF7RMANCE UF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRO 'fY TO PERFORM THE WORK FOR WHICN A9PLICATION IS WAD�AND 1 COMPLV WITH THE STATE <br /> CONTRAC RS LA 18,@7 RCW AND 296200 WAC. <br /> e <br /> � !3 ' � � <br /> igna ure o O nedContraclorlAuthorized Agenl Date � <br /> /y <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />