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s• CRMIT APPLICATiJN <br />CITY OF EVERETT PERMIT SERVj'CES <br />j <br />jss <br />3200 CEDAR STREET, EVERETT, WA yt3201 <br />5-257-8810 — FAX 425-257.8857 /1C J 304-6 ly6 <br />SITE ADDRESS / <br />PARCEL TAX I.D. it <br />PERMIT 4 <br />y1d_ Ta Aoe- VC' <br />LEGA LOT NO. BLOCK <br />TRACT <br />DESC. <br />OWNER ADDRESS ZIP PHONE <br />LET t,J -A - LP'LZ s ue- r 1M0tLLLJ,t; A14 �- zz <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />/ <br />L/ 16,3 <br />DA\19G-L `%So9a5`I- q-Li;- SNr 9LpU3 <br />Ic <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE N <br />?Ai_/riL \Ilt:w iJ,j,.ilN.t,tJ j-LC- CO20 T j- E,J0i,�'i7AJALL- LJ.V d14 <br />PHONE <br />,A 5•- 0 L!' C\l c'1k='li, LJJA `-Ald v <br />PROPOSED USE OF BUILDING <br />Building ai <br />dition <br />HEAT SE <br />AA T, <br />PERMIT Combilneation I ) Plumbing <br />TYPE Demolition D Sign <br />t <br />WORK for <br />TYPE �LJt New <br />eRCE <br />Gas <br />9t <br />Repair/Main1, <br />Other <br />CONTRACT PRICE OF WORK �� �.� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />'Z <br />WATER <br />UNITS <br />BATHTUB <br />S <br />FORCED AIRS STEMS <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />OWER <br />UNIT HEATERS <br />KIT N SINK &DISPOSAL <br />O <br />LOTHES DRYER <br />1 <br />DISHWA R <br />R GE HOOD <br />LAUNDRY <br />IJ <br />WA HEATER <br />CLOTHES WASH <br />METAL REPLACE/STOVE <br />_ <br />URINAL <br />_ <br />FIRE PLAC SERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIRI PLA <br />_ <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVFNTER <br />GAS PIPING <br />_ <br />SINK (SERVICE/B,�A/MOP/ETC.) <br />yJ <br />EXHAUST FAN <br />OTHER <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF WS AND ORi DINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRAN NG OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAq kAW REGULAT G CONSTRUCTION OR THE P2RFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER OF THIS RTY TO RFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />\18.27RC <br />CONTRACTORS A 296.200 WAC. <br />-13 J <br />Signature wner/Can act r/Autho Rzed Agent Date / <br />L� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />