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�ERMIT APPLICA�ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ,-� �9 � Ty �,�. � � xo3�a-c� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADURESS ZIP PHONE <br /> �/A.E'/ » ��.�/,�Z /�✓cls i `GC /�� io.�9 �� �`�=�� <br /> I CONTACT FOR PER IT � PHONE <br /> TENANTNAME I <br /> G�rcxy ���eryr�,�r �C '��'_ <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> pc/ P�goxJ.o�✓ <'-�s-r ' �.i�o ��� .r/�c//vc�s cr �i e���3 �x/ps"�-r`ois'e� <br /> PHON�E <br /> �� ��3a 9L d�i/s,g�,� o� ��3 <br /> PROPOSED USE OF BUILDING n Btlildiftg � Mechanical Additlon HEAT SOURCE <br /> PERMIT r-s Combination Plumbing WORK R Alteration � ElecUic <br /> 7YpE H Demolition Sign 7YPE D New Gas <br /> LJ Sprinkler �� Repair/Maint Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> / WATER CLOSET(TOILET) _ AIC—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> _� KITCHEN SINK 8 GISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD A-� <br /> LAUNDRY TR.4Y _ WATER HEATER y� l.l <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE ' (/ � <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREFLACE <br /> FLOOR DRAIN GAS RANGE: <br /> BACKFLOW PREVENTER GAS PIPING <br /> � SINK(SERVIC BAR/MOP/ET _ EXHAUST Ff,N <br /> OTHER � r S �'` � OTHER <br /> —f' o , � ��,��� <br /> ,�,�_ _�.Gy <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 GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUU+TING CONSTRUCTION OR THE 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 /> CONTRACTO LAW 78. 7 RCW AND 296.200 WAC. <br /> / � 6� <br /> S' nature of OwnedContra rlAuthorized Agent ate <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />