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PERMIT APPLICA � ION <br />' CITY OF EVERETT PERMIT SERVICES <br />� 3200 CEDAR STREET. EVERETT. WA 9820� <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS � PARCEL TA% I.D. p�°"�— PERMii x <br />- -1G�k� .L�1_'� - S Cc,�_��J y��Dv ��'�9 �� � >�/- c- lc- <br />LFGAL LOTNO. BLOCK TRACT <br />or-sc. �� �1�( �j� C•P _ � � o �iE� G <br />OWNEft � AODRESS ZIP PMON <br />��srx�Tc Lf-,C- �Yr��11���r�1�1 �� ��r�.�L%� 9�v�L 7 s-d;�3a <br />TENANiNAME CONTACT FOR PERMI�" PHONE <br />---------------�c4 �Nr�a,w,� 3�� (Sd-u8'd�f <br />CONTRACTOR ADDRES$ 21P CONTR. LICE_f�S��tc� <br />cX{aQ�ef� j �� I <br />PHONE _✓Ai"CE �g �.M.�IaI:� __ ____ _ ��S l 1�� � 0 H" H <br />PROPOSED USE OF Bl1iLOING Buildmq � MBCha�ical Add�liun I HEAT SOURCE <br />I PERMIT � Ctimbination Plumbing IWORK � AlteraP. � � Fler.liic <br />S¢�/. � TVPE D�malilion Sign TYPE New Gas <br />� Sprinkler Rnpav/Mainl Olhnr <br />CONTRACT PRICE OF WORH CITY OF EVERETT LOCAL SALES TA% CODE I° ]105 <br />WORK DESCRIPTION � f� j`� <br />/�.-f�,,,' � <br />PLUMBING <br />NO. � TYPE OF FI%TURF OR ITEM <br />� WATERCLUSET(iUll.l: f� ------. ._.-..-----� <br />'��SATNTUI3 <br />L�VATORV (WASH BASIN) <br />yl SHOWFR <br />/ hITCf-IEN SINh A DISPOSAL <br />I DISHWASHfR <br />IAUNDRYTR�V <br />,/�_ CLOTHFSWAtiN[R <br />URINAI- <br />DRINKING fOUNTAIN <br />FLOUR DRAIN <br />f3ACKFLOW PREVENTER <br />_ SINK (SfRVICE�(3ARIMOP�ETC.) <br />OTHFR <br />���1/� -������ ����3V <br />NO. I T�'PE OF FI%TURE OR ITEM <br />A/C - A/HANL'L!NG UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIRFpLACE/STOVE <br />FIREPLACE WSERT <br />GAS FIREPLACE <br />GAS RANGE <br />�AS PIPING <br />EXIiAUST FAN <br />OTIIER <br />I HEREfiV f,ERITIFV TI'A1 I HAVE REAU ANU EAAMINEU T415 APPLICATION AND 1(NOW THE SAME TO BE TRUE AND CORRECT AlL <br />PROVISIONS OF LAWS ANU ORIDINACES fiOVERNING TNIS TVPE OF N'ORK WILL PE COAIPLIED WITH WHETHER SPFGFIED HEREIN OR <br />NOT THE GRANTING OF A P[RMR UOES PlUT PRESUME TO GWF AU�HORiTV TO VIOLATE OR CANCEL THE PROVi510N OF AN� OTNER <br />STATE OR IOCAL LAW REGIILAT WG CqNSTRUCTiON OR THE PFRFORMANCE OF CONSTRUCTION THAT I AM AUTHORIZED 9Y THE <br />OWNER Of 7 IS 1'RUPFRTV TO PFRFOi7h1 TNE WGRH FOR WHICH APPIICATION IS MAOE ANU � COh1PL� WITH THE STATE <br />CONTRAC S LAW 10.2j Rs;W 4N0 2)9ti Qfi WAC r <br />� � � <br />i.�,�� �� �� U <br />Signa o l� ev(.unlrac�orAulhurired ayent Da�e � <br />' �� <br />` DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED ` <br />