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SITE ADDRESS <br />/ i <br />LEGA LOTNO. <br />DESC. �� 5 <br />L <br />� r'ERMIT APPLICA��iON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />BLOCK <br />PARCEL TAX I.D. N <br />V V <br />PEnRMIT M <br />� L' �� � O <br />���.STN�7L ��-,�,: �ru� i�ic�—a.-. ,�l.U, �y�t/NkJLUd.IL%{ JdU.�% (f�JS/ %f3 .O���l <br />TENANT NAME CONTACT FOR PERMIT —� PHONE <br />I �llE'L-G: Cs//Wd,tG� ,�v� �vSd -u�'d `f <br />CONTRACTOR AO�RE53 21P ���C��TS LICE.1���10� <br />PHONE �ar,� � C��� __ �GSTN�. q�HSH <br />PROPOSE7 USE OF BUILOING <br />CONTRACT PRICE OF WORK <br />Building Mechanical <br />aERMIT � Combination � P�umbing <br />TVPE Demolition Sign <br />Sprinkler <br />WORK DESCRIPiION �J /��� S�/ <br />�L� <br />PLUMBING <br />NU. I TVPE OF FIXTURE OR ITEId <br />WATER CLOSET (TOILET) <br />BATNTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />DISHWASHFR <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />ORINKING FOUNTAI�J <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE�BARlMOPif_TC.) <br />07HER <br />Addlllon I HEAT SOURCE <br />WORK � Allerallon � Electdc <br />TYPE New Gas <br />RepaldMamt Other <br />CITY OF EVERETT LOCAL 9ALE9 TA7( CODE 19 7105 <br />��� <br />NO. I TVPE OF FIXiURE OR ITEM <br />A/C - A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRVER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS �'IPING <br />EXHAUSTFAN <br />OTHER <br />� HEREBV CERITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRCCT. ALL <br />�� �ROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />I NOi iHE GRANTING OF A PERMIT DOES NOT �RESUME TO GIVE AUTHORITV �O VIOLATE OR CANCE;. THE PROVISION OF ANV (1THER <br />STAiE OR LOCAL l�W 7EGUlATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION THAT 1 AM AUTHORI2ED Bv THE <br />� OWNER OF T 5 PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATF <br />I CONTRACT � 5 LAW i9. C ND 296 00 �jYAC <br />I -t � / ' G <br />Sig tu I Owh dConlraclon ut nnzed Agenl Dele �/� � <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />'-- ------- ---- -- — -- <br />