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/ <br /> PE'RMIT APPLICATION <br /> CITY OF EVERETT PERMfT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 S `I a`� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 3 -a �: S�� -� o <br /> LEGAL LOTNO. BLOCK TRACT <br /> DERC. <br /> OWNEF ADDRESS � ZIP PH <br /> �rr�Ps l� �P�saH ��06 �n11 C:�v �GivN, IP� /�'�r„Z��t3,� _c�26 <br /> a �� <br /> TENANT NAME CONTACT FOR PERMIT ���Q� PHONE`6S ��T <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE S <br /> PHONE <br /> PROPOSEU USE OF BUILDING pEPMIT � Spr nkllealion U Plumbingal WORK �—( Repar/Maint HEAT SE ectric <br /> TYP� Demolition U Sign 7YPE �� New Gas <br /> l.] Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. 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 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(SE VICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> � 0 ER� S r Ce I�/�� ✓���� _ OTHER <br /> — 1-�ou�� — <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW T11C SAME TO BE TRUE AND CORRECT. ALL <br /> PRGVISIONS OF LAWS AND ORIDINACES GOVERNING TNIS TYPE OF WURK WILL BE COM'LIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTtIORITY TO VIOLA7E OR CANCEL TNE PROVISION OF ANY OTHER <br /> STATG OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMA.'JCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICFI APPLICATiON IS M DE AND I GOMPLY WITH THE STATE <br /> CO RACTORS LAW'10.27 RCW AND 296.20 WAC. <br /> �C� �Z �� <br /> Si ature of Owner/Contractod thorized Agent ate <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />