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F-CRMIT APPLICATI�N I� <br /> CITY OF EVERETT PERMiT SEF3VICES I <br /> 3200 CEDAR STREET, EVERETT, WA 9f1201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS C(�C2��''7` � �� PARCEL TAX I.D.# P MIT x <br /> 7. �� �l� �L S� ��Sro3 �37 <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. `� I»OL� /N G�/L/,J <br /> OWNER ADDRESS ZIP PH NE <br /> � <��_ �s��3v <br /> _l7Lif/� � S/ltifi`f c����S— /Ofi�dr sc= ti f�L2L—Y'� ���D <br /> TENANT NAME � CONTACT F09 PERMIT � PHONE <br /> 9/f'/rl L- S/I-/il � <br /> CONTRACTOR AODRESS ZIP CONTR.LICENSE H <br /> PHONE <br /> PROPOSEDUSEOFBUILDING TYPEIT Demol9o1n n U Signb�n9al TYPE � AaPaidMainL HEATSGec�tnc <br /> c.-, l ` <br /> /� Sprinkler � Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> � G�l�� .,/�6�r��C �,lr`���/�"n`��� � �,�`'�''�`� �`v, <br /> � <br /> �i , <br /> PLUMBING �7ECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR REM <br /> WATER CLOSET A/C–A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HE.4TERS <br /> KITCHEN SINK& DISPOSAL CIOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUtJTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK fSERVICE/6ARlMOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I <br /> I HEFiEBY CERITIFY THAT I HAVE fiEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TR�E AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND C'RIDINACES GOVEANING THIS TYPE OF WORK WI�L BE COMPLIED WITH WHETt'ER SPECIFIED HEREIN OR <br /> NOT. THE GHANTING OF A PE�RMIT DOES NOT PRESUME TO GIVE AUTHOFITY TO VIOLATE OR CANCEL THE aHOVISION OF ANY 0?HER <br /> STATE OR LOCAL LAW REGUI "'NG CONSTRUCTION OR THE PEflFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHOflIZED BY THc <br /> OWNER OF THIS PROPERTY f0 PERFORM THE WOqK FOR WHICH APPLICATION IS MADE AND I COMPLY WIT�i THE STATE <br /> CONTRAC RS LAW 18.27 A'�V AND 296�06 WAC. <br /> �; <br /> , - �i - ���a�G� , <br /> Signature of Owner/ ntrac(orAa /ori�� Date �/Z;, <br /> i DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> � <br />