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��wERMIT APPLICAT'ION <br /> CITY OF EVERETT PERMIT SEaVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS � PARCEL TAX I.D.# PERMIT# <br /> 38 D � f�l �Vefe�i 111o3ns-oa3 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> JWNER A[7DRESS ZIP PHONE <br /> C',a„�Io� ,(,�.�6r�- c°� 38a� aG �PI 98aai �lLs -zSS-oBos <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> Oan,�:ti P�n�izs�ti sk,�,� <br /> CONTRACT02 ADDF.ESS ZIP CONTR.LICENSE# <br /> PHONE <br /> PROPOSED USE OF BUILDING Building I� MeChaniCal Addilion HEAT SOURCE <br /> PERMIi � Comoination ���� PlUrtlbl�g WORK R Alteralion � Electric <br /> I--( <br /> TYPE Demoliti0n L7 Sign IYPE � New Gas <br /> Sprinkler �� RepairlMaint. Other <br /> CONI•'�SCT PRICE OF WORK Q� j Q/ 00� CITY OF EVERETT LOCAL SALES TA7C CODE IS 3105 <br /> `�. <br /> WORK DESCRIPTION � !1 J p 1 �,,/J / <br /> ._tiNs „{!(.4.TNu �1'� J�ar �OGlS2 �P��I-RA-'1G. Cl�OcO� K'l3T' <br /> — -/ / <br /> �� Q.{I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATERCLOSET(TOILET) _ A/C—A/HANDLINGUNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER NETAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS R,4NGE <br /> BACKFLOVJ PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER � OTHER Elu C�oI/PcF�cr� <br /> — _ �<c, /rw <br /> I HEREBY CERITIFY THAi I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO P,c TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERiVING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN�:-i <br /> NOT. THE GRANTINIi l�F A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OP.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 /> OW ER OF THIS PROPER O PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE '� <br /> CON CTORS LAW 18.2 R W 296.200 WAC. ��� <br /> �� � ���s� S � t 3 II <br /> Signature of Owner/Contrector/Authonzed Agent ate I <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED �/L I' <br />