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SITE ADURESS <br />LOT <br />NERMIT APPLICAT�t�N <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 TAl( I.D. M J�"' � <br />?1Ya 5� / �/in z� t C`i0 <br />C�� �lv -Li <br />PERMIT • <br />c_o�� v - o � <br />J7r.�rH�i� �F..,�., �o� i•io-a.-. ,�ru, .v,vwr,r�,;�r� yxv�7 cY�,�/ �rs-aa�a <br />TENANi NAME CONtACT POR PERMIT PHONE <br />I �t,F_ -��' LN/J.�G,[,G� 13��� �S6 -c��'d 'f <br />CONTRACTOR ADDRES9 21P CONTR. LICE.rySOE� � <br />tX{�2i�`� �j �p � <br />PHONE ,��� � ��� ��ST1,� 1�7N" H <br />PROPOSED USE OF BUILOING <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />Building Machanical <br />PERMIT � Combinatlon � Plumbing <br />TYPE Demolllion Sign <br />Sprinkler <br />�� S'f� <br />NO. I TYPE OF F1%TURE OR ITEM <br />�WATER CLOSET (IOILET) <br />BATHTUB <br />�IAVATORY (W 4SH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />T DISHWASHER <br />LAUNDRYTRAV <br />1_ CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />_ BACKFLOW PREVENTER <br />__ SINK(SERVICE/BAR/MOP/ETC.) <br />OTHER <br />/ <br />Addllion I HEAT SOURCE <br />WORK B Alterallon � Elactrlc <br />TVPE � New I Gas <br />U RepaIdM2lnt Olhar <br />CITY OF EVERETT LCCAL SALES TAX CODE 19 910� <br />MECH \NICAL <br />�^J. I TYFE OP FIxTURE OR ITEM <br />A�G — A/HANDLING UNITS <br />_L FORCED AIR SYSTEMS <br />__ HEAT PUMP <br />UNIT HEATERS <br />� CLOTHES DRYER <br />RANGEHO00 <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN � <br />OTHER <br />I HEREBV CERITIFV THAT I HAVE READ ANO EXAMINED THIS APPLICATION AND KNOW THE SAME TO 9E TRUE AND CORRECT ALL <br />PROVISIONS OF U1W5 AND ORIDIN�CES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. TNE GHANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO :'IOLATE OR CANCEL THE PROVISION OF ANV OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRI ICTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNOFIZED BY� THE <br />OWNER OF TNIS PROPERTY TO �ERFORM THE WORK FOa WHICH APPLICATION IS MADE AND I COMPLV WITH THF. STATE <br />CONTRA RS LAW 18. R'W AND 296 WAC <br />�t-� % Q U <br />Sign o nedConlractor! uthor¢ed Agenl ate <br />/ DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED �/Z� <br />