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w/o 0y14 <br /> 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 ADDRESSPARCEL TAX I.D. # PERMIT# <br /> 172 - cyn"'A167cinoQ0000 I Moyo&-ou I <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. fFj <br /> OWNER ADDRESS ZIP PHONE <br /> :t� �L, o a73 �18�'�10RD (?gao.5 3:f3- 5�45(v <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR.._ _ \ ^ a,�� DDRESS — p.�(�r6 21P CONTR.LICENSE# <br /> �JII YTAL�V-�C `.�"�\ t ye�'Sa mSe..e�Tml►lo3R:XY1 <br /> PHONE " &be 853- CIo7o? <br /> PROPOSED USE OF BUILDING �1 Building Mechanical +,�L7c Ad'1 11wn HEAT SOURCE <br /> PERMIT R Combination Plumbing WORK Alteration 7f.� Electric <br /> TYPE B Demolition Sign TYPE NewfL,.tV1 Gas <br /> Sprinkler Repair/Mainz Othr• <br /> CONTRACT PRICE OF WORK OO, OO CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> PLUMB'NG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL CLOT'1ES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY __ WATER HEATER <br /> _ 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.) EXHAUSz FAN <br /> OTHER r OTHER lr,�C l�-rY�}- o�• S'}or� <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 CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWN R OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT ACTORS LAW 18.27 RC' AND:96.200 WAC. <br /> 9- W <br /> Signature of C" <br /> tr, tor; Date <br /> DE13ft& CREDIT CARDS ARE NOT ACCEPTED <br />