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� <br /> PERMIT APPLICA�-ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE DDRESS �`1 � � PARCEL TAX I.D.# PERMIT# <br /> f� 7 OC70viy0�0 C� tl-rrL <br /> LEGA LOT NO. BLOCK TRACT <br /> D'cSC. / � <br /> (�.l,En�}jq-VEN E1L.kT5 # L <br /> OWNER ADURESS ZIP PHONE <br /> � � v �zir�A � _� �v�Xl�lreti�� �I 3� -�(�1 ��1�� S � T(l� �fnC�^���n_ 795(� <br /> TENANT AME ., CONTACT FOR PERMIT PHONE <br /> 1vtS 6--wt6�c.t �� , , ,� <br /> ��-� . :,��, I cti� S L��e���L x ��s���^ ��o <br /> QONTRACTOR qDDRESS ZIP CONTR.LICENSE# <br /> ��—i ,� C�vtS`�-��crc �-iG��� (oc�t Z�2�'^ S� Sw t�eD�Nc.�` 3s2BT <br /> PHONE <br /> L�nnu�x+c� �l�;�o <br /> PROPOSED USE OF BUILDING Buil�ing Mechanical f�.�,d Cition HEAT SOURCE <br /> PERMIT ombination RI..( Plumbing WORK K1.1 Alteration R�ElecVic <br /> TYPe Demolition U Sign TYPE u New GJGas <br /> Sprinkler U RepaidMaint. U Other <br /> CONTRACT PRICE OF WORK /�/ �O� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION /� <br /> �� 0.S-�lb�i'l� / 1 G�Gt I�f b'y( � F�G'�IO�� � �— <br /> �'��� ;�o �u�t�� �C�Z(�Z,�Z <br /> PLUMBING MECHAI^iICP.' <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 UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISi�WASHER 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 /> T 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 i-OVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN 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�ROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOR ` W 8.�C AND 296.200 WAC. <br /> � ' � ! - 3 -03 �f2 <br /> Sign�e o Own dContrectodAuthorized ent Date <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED /� p ' �—O �/� <br />