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P�r�MI� APpLICATlOnI <br /> CITY OF EVERETT PERMIIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> 6— ai--o <br /> SITE ADDRESS PARCEL TAX I.D.# PERMi7;. <br /> ' �' �r� � � U`-1o�r-f 6cX.v <br /> � <br /> LcGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER �\ ADDRESS ZIP PHONE <br /> �' \ �'Cut_/ � }�\�i� 1�,1� I "l� ` .\-`- �k,��l (�L.�5�3;3/y� <br /> TENANT NAME CONTACT FOR PERMIT PHONT <br /> ��U�Lti�1 �� L � �11.1�1�1_('.N �� l�(' � 1 / ��a`� ��i � �%U� � <br /> CONTRACTOR ADDRESS i� ZIP CONTR.LICENSE# <br /> f'HONE <br /> PROPOS[D USE OF BUILDING Building D MCchanical fl Addition HEAT SOURCE <br /> PFRMIT Combination �}Plumbing WORK �_� Alteration R Electnc <br /> TYPE Demolition U Sign 7YPE �29 New �.j Gas <br /> Sprinkler �.l�j RepairlMainL U Other <br /> CONTRACT PRICE OF WORI( CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKOESCRIPTION �Z;.tl��..<C L'GS�S`�..��J i��l,��'���i .\C-� (,ldC� C;C�CI G��(til��C � IG--( . <br /> \1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 1 WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> 1_ BATHTUB FC'RCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) HEr T PUMP <br /> SHOWER UNII �iEATERS <br /> � KITCHEN SINK&DISPOSAL C.LOTH,=S DRl'ER <br /> � DISHWASHER RP.'i��E HOOD <br /> LAUNDRY TRAY WA i tH HEATER <br /> � CLOTHES WASHER ME'(AL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <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 <br /> I HERE9`i CERITIFY THFT I HAVE READ AND EXAMINcD THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRFCT. ALL � <br /> PROVISIONS OF IAINS AND ORIDINACES GOVERNI�G THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIEC HEREIN OR <br /> NOT, THE GRANTING OF A PERMI7 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 Al1THORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE 4NORK FOR WHICH APPLIC.4TION IS MADE AN�I COMPLY WITH TH�SiATc <br /> CONTRACTORS LAW 18.27�CLy AND 296.2001YAC. j, <br /> � � <br /> ;;�� ;� '� ' � l (,C-r ,� <<���a I�CZ� � � <br /> '�Sign—atuT,e o n`erZ`ontractodAu ho zed Agent Dace i I <br /> i <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED I <br />