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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857 <br /> - �_- y�� -os <br /> SITE ADDRESS � �19 �p'f� /{�j� S�. PARCEL TAX I.D.# PERM'IT/p <br /> v eff W ` �Yo I S O yV� OU7 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> _Pav�a �lI¢�r� I��IP ��' �t4 ,9�� s� �up�re.�c�H9�'�d� �'�-- 33�— tbj <br /> TENANT NAME ����M S � CONTAC7 FOR PERMIT PHONE <br /> —C ��,eky Tpn.,�,l� � ) F�'rk I ��y .My�>,v�� �fZJ'-- �vv -�kk� <br /> CONTRACTOR AUDRESS ZIP CONTR.LICENSE� <br /> ivkrtv- S�s �d�r/� /rwY 4f 1=(-� �yq�iu':r-� (uH f'��37 I,uhrTEuI976 7 <br /> PHONE <br /> �F2�_ 7V�F-o�`F� <br /> PROPOSEO USE OF BUIL�ING Building Mechanical Atlditbn HEAT SOURCE <br /> PERMIT � Combinatlon �Plumbing IWORK �Alleretbn I n ElecUic <br /> 7YPE Demolition Sign 7VPE N¢w Gas <br /> Sprinklef RepairlMainl. Other <br /> CONTRAC7 PRICE OF WORK ' c��/ p�V � CITY OF EVERETT LOCAL SALES TA7C CODE IS 3105 <br /> WORK DESCRIPTION / ` n �� ,J� �e <br /> �2/S'�C1.I.( C(�C/fl�I RX KX�1�1-a-L. L•v� /�R�R cvu� ��J �, c-u��-C . <br /> ! <br /> PLUMBING MECHANICAL <br /> I VO, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � _ WATERCLOSET AIC—NHANDLINGUNITS <br /> _ BATHTUB FORCEDAIRSYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNITHEATERS <br /> _ KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACEISTOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOPIETC.) EXHAUST FAN <br /> OTHER OTHER <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 NPE OF WORK WILL BE COMPLIED WITH WHETHER SP'cCIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW ftEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONuTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM T WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 W <br /> �1� , �l� �i o <br /> Signature of OwnedContractoNAuthonzed nt Date <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTE6 /L <br />