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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES �—�{�� <br /> 3200 CEDAR STREET, EVERETT, WA 982 <br /> 425-257-8810-FAX 425-257-8857 gP ��Z -GGS-pZ, <br /> ��Zo3 <br /> SITE ADDRESS PARCEL TAX I.D.# PER # <br /> c�� ��,! 5. r-. s3 o D O ��0�D/ <br /> LEGA LOTNO. BLOCK TRACT <br /> oEs�. �— .cu QrR s�� Qr�Or- �loT3 Srsc 3/ TwH�I H iPASr , <br /> OWNER ADDRESS LP PHONE y�s- <br /> � <br /> � O- <br /> TENANTNAME I CONTAC7FORPERMR PHONE <br /> �u� /�i�/�/<!� � - <br /> ��N� � uSr /f l�DDR� �^� ZIP CONTR.LICENSE# <br /> li' �� 'J <br /> PHONE <br /> Y����iD - ]r� "� /� (/Fz �� �,l/ 4��J� /��..�HGlo/O[3�9 <br /> PROPOSED USE OF BUILDING 8 'Id(ng Mechanical Additlon NEAT SOURCE <br /> PERMIT �,olmbination � Plumbing WORK �tlon Eledric <br /> '� T'PE R Demolition U Sign 7YPE ew as <br /> `''�G�-/c �/��/[- `'j U Sprinkler RepairlMalnt. Other <br /> CONTRACT PRICE OF WOR CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION ��IN SIhI�TL� FAMII.Y R�$II7�AIC� W �3� CAiC GO�.AG�. <br /> G��k� �a����r.d�' . <br /> PLUMBING MECHANICAL <br /> NO. TYpE OF FI%TURE OR ITEM N0. . TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET(TOILET')� A/C-AIHANDLING UNITS <br /> BATHTUB' � FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) ' HEAT PUMP <br /> / SHOWER UNITHEATERS <br /> _(_ KITCHEN SINK&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 /> I 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 TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GR,4NTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE 0 LOCAL LAW REGULATING CO RUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNE THIS PROPERTY M HE WORK FOR WHICH APPLICATION IS MADE AND I COMFLY WITH THE STATE <br /> CON ORS W 1 RCW AN 2 00 WAC. <br /> ignature of Ow er dAutho ' Agent at � <br /> L <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />