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� ERMIT APPLICATiJN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98?_01 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS t� PARCEL TAX I.D.# PERMIT a <br /> ;�29 Po3a3-oaS <br /> LEGA LOTNO. BLOCK TRACT <br /> �ESC. <br /> OWNER AODRESS ZIP PHONE <br /> _ i�ia�i��r �/�� /� ,ecc> ��1�B 2S�S7- �S�ol y�aS2-S/663 <br /> TENANTNAME I CON1'ACTNAME PHONE <br /> CONTRACTOR ADDRESS LP CONTR.LICENSEM <br /> PHONE <br /> PHOPOSE�USE OF BUILDING i Building D Me^hanical Addition HEAT SOURCE <br /> � PERMIT R Combination �j Plumbing WORK R Alteration � Electric <br /> TYPE g Demolition U Sign TYPE g New Gas <br /> Sprinkler RepaidMaint. Other <br /> CONTRAC7 PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK�ESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET 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 /> DISHWASHEA RANGE HOOD <br /> LAUNDRY TR:�Y WATER HEATER <br /> CLOTHES WASHER METALrIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICJBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE S.4ME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOFITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LqW REGUTATINi3 CONSTRUCTION OR THE PERFORAtANCE OF CONfiTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF TH 'PROPERTY�IO PERFOR��HE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC�LAW 78.27 RCN/7tND 295.200 WAC. <br /> / �� � <br /> .����z<� yly;��/-.•/Z�s, -� �/7�� <br /> Sigri3ture of OwneUContractodAuthorized Agent Date <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />