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. _ � _ i -_ - <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 /> S�TE ADDRESS PARCtL TAX I.D.q PERMIT x ' <br /> �5,� � - lLa�' �. l�l. l�n , ,3" �3c�f-�� � <br /> D SC. LOT NO. / BLOCK TRACT <br /> . �l � �-C��N��.�.��C���ES <br /> OWNER ADDRESS LP PHONE I <br /> C��C�r-�-, \�C.�W`0 S\��F�S��\�U�\�'��\ '�N�\ ,w'\� . ��a��� ! <br /> TENANT NAME CONTACT NAM`e ru�S 1 . F(�`� PHONE `��L I <br /> N\� ���\�C�i���` �3���`��:,, v�.�,�3� � ���0� ay ,� , <br /> CONTRACTOR qDDRESS � ZIp CONTq.IJCENSE�\RI� I <br /> PHONE ��1,G�O��iVU i <br /> 5���. �cP IGlaa;o3 I <br /> PROPOSE�USE OF BUILDING Building Mechanical Addilion HEAT SOURCE � <br /> S � � PERMIT �Combina�ion�Plumbing WORK �Alleratlon �Electric I <br /> TYPE Demolition Sign TYPE New Ges <br /> Sprinkler(M ol heeds) Repuir/Meint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> WORK UESCRIPTION <br /> ����� \�3�:� <br /> � � � �\���� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM NO. TYPE OF FlXTUHE OR REM <br /> ? WATER CLOSET(TOILET) NC—A/HANDLING UNITS <br /> � BATliTlJB � FORC[D AIR SYSTEMS <br /> � LAVATORY(WASH 9ASIN) HEAT PUMP <br /> SHOWER UNIT FIEATERS <br /> �_ KITCHEN SINK&DISPOSA� � CLOTFIES DR'VER <br /> J_ DISHWASHER � FiANG[HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> �_ CLOTHES WASHER _ METAI.FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DFiINKING FOUNTAIN GAS FIREF'LACE <br /> _ FLOOR DRAIN � GAS RANGE <br /> BACKFLOW�REVENTER GAS P�PING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I hIEREBY CERITIFY THAT I HAVF RF4p AND EX�61 W[D THIS APPUCATION AND KNOW TI1E SAME TO BE TRUE AND CORP.ECT. ALL <br /> PROVISIONS OF LAWS AND(1FlID�id!!CES GOVERNIfJG THIS TYPE OF WORK SNILL FiE C01dPLIED WITII WhIEThIER$PECIFIED HERFIN pR <br /> NOT. THE GRANTING OF A P[HF.11T DOES NOT PRGSUfdE TO GIVE AUTHORITY TG VIOLATE OR CANCEL THF PRO\9SIOI1 OF AN1 (il l l[!7 � <br /> STATE OR LOCAL LAW REGULAI'ING CONSTRUCTION OR THE PERFORMANCE OF COIJ$iRUCTION. Tf IAT I A1,1 AUTI IOIiIZ[U B'i TI IF ' <br /> OWNEF O IS PROPERTY TO I'EFFORM TH[WOf1K FOR WHICH APPLICATION IS MADE.4ND I COMP�Y WIiH TNC STATE <br /> CONTR TOR LAW 1827 fiC6'J ND 29G.200 WAC. <br /> i � <br /> �.-�' �,�--� ►/ ��fa a <br /> Signature ol OwnedContractod�uthonzed Ayent Dale i' ' <br />