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� <br /> I PPLICA�I aON I <br /> r�E�MaT A <br /> CIT'Y OF EVERETI' PERMIT SERVICES , <br /> 3200 CEDAR STREET, EVERETT, `JVA 98201 � <br /> 425-257-8810 - FAX 425-257-8557 <br /> I SITE ADDRESS / PARCEL TAX I.D.#3"L� -- PERMIT# , <br /> ��/ " /�� �/ �L� �5'�� /,3�aU �SS l�LJ �' �, .�(� — �(�/ � <br /> LEGAL LOTNO. BLOCK TRACT -�/ � , I <br /> DESC. � �.(7 - ' C ' D �/�J G- I <br /> OnWNER DDRESS ZIP PHON I <br /> /--�r�.v�TG �,�..,G:� D. r G�' = _�; ,.�d�«n Gi.� 9�3_Z ��Sl 7s`S-d�3� <br /> ENANT NAME CONTACT FOR PERMIT� � PHONE <br /> �liE'C� C.r//�lir�'.C��,LiC �.�UG�� /v.Sll-US''11 '� I <br /> CONTRACTOR A�DRE55 ZIP CONTR. LICENSE# <br /> ��c���s �I�l�4f <br /> � PHONE �f'�M.E � �l-UN,r�. 1 7�S ` ���. �0 '1� N <br /> I PROPOSED USt OF BUILDING I� Ouilding � Mechanical I� L. .uition HEAT SOURCE <br /> PERMIi p�� Combinalion Plumbing WORK 6� Alteration � Electric <br /> ��� TYPE �j Demolilion Sign TYPE � New Gas <br /> U Sprinkler Repair/Mainl. Other <br /> CONTRACT PhICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I <br /> I WORKUESCF:IPTION iJ /�i` 1 �C� `�,� /����� -[�+'- ��,�� <br /> Nr� CJ ��t E1rr <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I � WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> /'!. BATHTUB _� FORCED AIR SYSTEMS <br /> i y LAVATORI'(WASH BASIN) _ HEAT PUMP <br /> � � ' SHOWER UNIT HEATERS <br /> I � KITCHEN SINK 8 DISPOSAL � CLOTHES DRVFP. <br /> i � DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> I % CLOTHES WASHER _ METAL FIREPLACElSTOVE <br /> I _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN � GAS FIFtEPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER ,�_ GAS PIPING <br /> SINK(SERVICE/BAR/MO?/ETC.) � EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAIJiE 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 DOES NOT PRESUME TO GIVE AJTHORITY TO VIOLATE Oft CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR TNE PERFORM17ANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER O�THIS PROFERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY N/ITH THE STATE <br /> CONTRA ORS LAW 10�7 FjCW AND 296 QD WAC. <br /> I <br /> � = -� L� , '�... v�,7 U <br /> � SignaW e of nedCoNractor/Authorized Agent Date �/� <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED \' <br />