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PERMIT APP�ICATIO�d <br /> CITY OF EVERETT PERMIT SERVI'CES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT iF <br /> f I4-fi Ut= SE , -r�• � G -ol <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. OS '� <br /> OWNER ADDRESS ZIP PHONE <br /> TENA�T NAME �� ('�� CONTACT FOR PERMIT PHONE <br /> /� I _ d / ) <br /> SI UCC L G ',ci�l�.J S�h h �J'1 ( o�l/k-� �IL�- $'Lg �S )o? <br /> CONTRACTOR �— ADDRESS 21P CONTR.LICENSE iF <br /> No�TN W�.ST �Plumba�, <br /> PHONE <br /> 3bn - 6s3 • z�-1 _t � Zz <br /> PROPOSEO USE OF BUILDING pERMiT Y-S Sprinklleation � Plumbing al WORK �Repair/Maint, HEAT SE ecUic <br /> TYPE K Demolition Sign 7YPE New � Other <br /> [nr�� S�Up LJ <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK OESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. � TYPE OF FIXTURE OR ITEM N0. . TYPE OF FIXTURE OR ITEM <br /> �_ WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> 1 LAVATORY(WASH BASIN) HEAT PUMP <br /> 5HOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWAS4ER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIRFPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> � SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> _L WY1T� Flccn'tc� _ <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE'fRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL 3E COMPLIEO WITH WH`THER SPECIFIED 4EREIN 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 REGULATING CONSTRUCTION OR THE PeRFORMANCE OF CONSTRUCTION. THA7 I AM AUTHORIZED BY THE <br /> '7WNER OF THIS PROPERTY TO PERFURM THE WORK FOR WFICH APPLICATION I5 MADE AND I COMPLY WITH THE STATE <br />� ��ONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> Signature of OwnedContractodAuthonzed Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />