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f�ERMIT APPLICATI�i�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CFDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS �j eZo 8 PARCEL TAX I.D.# PERMIT# <br /> ro � ;� _ -� �w.E;� oSzooaLos000 , � o3�0-a�� ' <br /> w <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS � 21P PHONE <br /> aBsog C°IzS/ 33� 7S�Z <br /> E�'���� Astil� GG 2.C�/ L h/.sx.i lo I o 9 2 S � Nu� �Grua[6irw� �, <br /> TENONT NAME CONTACT FOR PEF.MR ���L y a T PHONE I <br /> 3'39 G-�9 Z <br /> Eu B.,E c.<�� yzt 4'-rb i�/3 S <br /> y fr,�,., .- a.K, tia s a a � � rt� <br /> CONTRACTOR ADDRESS ZIP GONTR.LICENSE# <br /> PHONE �� �f(1L) II <br /> PROPOSED USE OF BUILDlNG Building � Mechanical Addidon HEAT SOURCE �I <br /> SPERMIT g Combination Plumbing WORK � FUteratlon � Electric <br /> �i3/f TYPE D Demol(tion Sign TYPE New Gas <br /> ° ��— U Spfinklef Repair/Maint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION ' <br /> � `�/"' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP fIXTURE OR ITEM NO.. TYPE OF FIXTURE OR ITEM <br /> WATER t•���SET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSA'. CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTNES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br />' DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> I _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ ANp EXAMINED THIS APPLICATION ANO 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 HEP.EIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STqTE OR LOCAL LAW REGULATING CONSTRUCTION Ofi I'HE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> Y� . �. . ���j���,�' �d f0 � � �� <br /> Signa of Own�/Contrac d�f/Authonzed Ager.t Date � <br /> I DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED ' <br />