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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 /> SITE ADDRESS PARCEL TAX I.D.# E iT tt � <br />, �So3 ��lv• �9vc :d LNGI�r� W39 9S�a�;� �� - da� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> Ton�M�� ; n7�ir-��n NHsc�noN �s�� ���� t�vc lu G✓GI�r1- !uL)� ���f (�a-sJ 37' '✓'�-� <br /> TENANT N E I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> PHONE <br /> / !'`) • n �, ' <br /> /�-ci v <br /> PROPOSED USE OF BUILDING f'l Building fl Mechanical AddiUon HEAT SOURCE <br /> PERMIT �__� Combination H Plumbing WORK Alleratlon Q Electric <br /> TYPE �l Demolition L/ Sign TYPE New �j Gas <br /> U Sprinkler RepaldMaint. LJ Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TNC CODE IS 3105 <br /> WORK DESCRIPTION <br /> f+i�,c,� f �— �•.�.� v�l�� �Gut�, n-j �� of S/�2 � -�- o� 1�{ <br /> PLUMBI G MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NU. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) AIC-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACEINSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFV THAT I HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL 6E COMPLIED WITH WHETHER SPECIFIED 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 REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW ANJ 296.200 WAC. <br /> Signature of OwnedContracror/Authonzed Agent Dale <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />