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� PERI�AIT APPLICATIqN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE AODRESS PARCEL TAX I.D.# PERMi7 a <br /> - �rr�/ • !�'IG3o5-o�U_ <br /> LEGA L TNO. BLOCN TRACT <br /> DFSC. <br /> OWNER ADORESS 7��� I L�.� �r� �IP PHONE t�),S-y)3 �/3 <br /> � � �/� ♦ t/ C� <br /> ! � {' / " I /U � <br /> TE AN NAME I CONT CT FOR PERMIT PHONE <br /> CONTRACTOH,'� �/f /���� ADDRESS ZIP CONTR.L�CENSE N <br /> � ���/ <br /> PHONE <br /> PROPOSED USE OF BUILDING TMPEIT B DPrmnklltlo`n�n u Sign binga' TMPEK � Repalr/MainL HEAT SGe9 ric <br /> � D�h9f <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL 5ALE3 TA%CODE IS J105 <br /> WORK DESCRIPTION <br /> PLUINBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM NO. riPE OF FIRTURE OR ITEM I <br /> WATER CLOSET(TOILET) A/C-A/HANDLING UNITS I <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRl'ER <br /> DISHWASHER RANGE HO00 <br /> LAUNDRY TRAY �� WATER HEATER t�f <br /> CLOTHES N'ASHER METAL FIREPLAC�STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN _,= GAS FIREPLACE <br /> FLOOR DRAIN oa GAS RANGE <br /> BACKFLOW PREVENTER �C GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBV CERI'IFY THAT I HAVE READ AND ExP.MINED THIS APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING C01'STRUCTION OR THE PERFGRMANCE O`CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM TME WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITM THE STA�E <br /> CONTRACTORS LAW 182'I3CW F�J�.96.200�NAC. ' <br /> A ��.���' � ��� �. � �U� <br /> S nal re of Owner ontract d thonzed Agent ate <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />