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—� � � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857 <br /> � <br /> PARCEL TAl(I.G.l� PERMIT# <br /> SITE ADDRESS 3��i� <br /> �L' �i J �� J`� <br /> LEG LOTNO. LOCK TRACT <br /> DESC. LP PHONE <br /> OWNER ADDRESS <br /> '�. <br /> �ou9/os�, / ,� �,ff Sa.�. -42 - , <br /> —�� I CONTACT FOR PERMIT PHONE <br /> TENANTNAMC � <br />� ADORE55 - ZIP CONTR.LICENSE M <br /> CONTRACTOR <br /> PHONE <br /> PROPOSED USE OP BUILDING � Building MechaniC21 AddWon I HEAT SOURCE <br /> PERMIT COmbine�i0� � PlUfnbi�g IWORK � Al�eratlon � Gag^� <br /> I TYpE Demolition Sign TMPE RepairlMaint. Other <br /> Sprinkler <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORK DESCRIPTON �e r�(' �5� / /1 Ch���js <br /> T� /ILl[ r 02 v-- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fl%TURE OR ITEM <br /> NO. TYPE OF FIXTURE OR REM <br /> WATERCLOSET _ aC–AIHANDLING:)NITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> lAVATORY(WASH BAS�N) _ HEAT PUMP <br /> UNIT HEATERS <br /> SHOWER — CLOTHES DRYER <br /> KITCHEN SINK&DISPOSAL '-- RqNGE HOOD <br /> DISHWASHER — WqTER HEATER <br /> LAUNDRY TRAY METALFIREPLACE/STOVE <br /> C!^THES WASHER — FIREPLACE INSERT <br /> UttINAL — GAS F�REPLACE <br /> DRINKING FOUNTAIN — GAS RANGE <br /> FLOOR DRAIN — GAS PIPING <br /> BACKFLOW PREVENTER — �(HAUST FAN <br /> SINK(SERVICEBAR/MOP/ETC.) — OTHER <br /> OTHER _ — <br /> I HEREBY CERITIFY THAT�HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> S�A7E OR LOCAL'LAW R GUTATING�ONS RUCT OSN OR THE ERFORMAN E OF CONSTR CT ON.CTHAT I hM A TIHORIZED By 7�j{E ER <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> COt��OR�18.� W�96 00 WAC. /' � '� <br /> U <br /> Signature of OwnerlContractorlAu onzed Agent Date <br /> DE�siT&CREDIT CARDS ARE NOT ACCEPTED <br />► <br />