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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.0PERI IT 0 <br /> 1 - � Lam . ?lc>L4al�.�'��000 I 0903021 <br /> LEGAL LOT NO. Bl )CK TRACT n <br /> LF.SC. 15 CT C VV wc7pcS.l (�c�.•ga.r <br /> OWNER ADDRESS ZIP PHONE <br /> _F_ nd �u�se•� . L� >: AueSE 30� alas' �v3-171Q <br /> TENANT NAW I CONTACT FOR PERMIT PHONE <br /> I._t,1J Le'ssLw„ 4ks' -"1,F3-018 <br /> CONTRACTOR ADORESI ZIP CONTR.LICENSE 0 <br /> Nu\R (� <br /> �=(1�2121$ES l I�'�3'3T �UrSE �1uL1 �i$G17 /�DATR[u�3�e.1 <br /> PHONE <br /> {� <br /> 41Ls--1`13- ( 1 <br /> PROPOSED USE OF BUILDING PD <br /> uilding �[�y'Mechanical I Addltlon HEAT SOURCE <br /> PERMIT ombination � Splugmbing WO' A Allarallon �lecutc <br /> TYPE emolillon U SI n TYPE [[5,1-pew as <br /> prinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> N z� �Lc•�1� -l' trik��� 1��� �� aac��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> _A BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> I DISHWASHER _ RANGE HOBS (rvecu <br /> LAUNDRY TRAY WATER HEATER <br /> T CLOTHES WASHER _ METAL 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 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE 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 CONSTRUCTION OR THE PERFORMANCE OF CrJNSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 298.200 WAC. <br /> 3 � (S(D4 <br /> Signalu'rl of Owner ontracto /Authorized Agent Dale <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED I/7 <br />