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PERMIT APPLICATI�N <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./t PE,�RM�IvT a� <br /> ' ` `Z; 9�`I /D O �S/`f'�7'd I I <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> 1�'e5�f' <br /> ,�� 1 e /y,7,o m S//�n i4� �tl 3 9/ �v�r�7Y 9B� N�S"�5'� -a7o1 <br /> TENAN AME I CONTACT FOR PERMIT PHONE <br /> ° / c> � o x /6 <br /> CON ACTnR A�DRESS ZIP CO TR.LICENBE k <br /> Z �Z p t� <br /> PHONE <br /> `L„2�= 33 �. 7l� � �� C��� �/a5` - ^ - <br /> PROPOSEDUSEOFBUILDING I pERM1T � Sp�lnk'Iea�lOn � Plu binga' WORK �i R P�pMa1n� �{EATSEectric <br /> IYPE Demolition Sign TYPE D New U Gae <br /> � U L.) O�her <br /> CONTR PRICE OF WORK �_L� � CITY OF EVERETT LOCAL SALE9 TAX CODE 19]106 <br /> 1 <br /> WORK DESCRIPTION � <br /> � �) � LY E' Ci � C C <br /> PLU ING �dECHAN CAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FUCTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASN BASIN) HEAT PUh1P <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES 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.) EXHAUST FAN <br /> OTHER OTHER <br /> I <br /> i <br /> ; I HEREBV CERITIFV THAT I HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � PROVISiONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL OE COMPUED WITH WHETMER SPEC�FIED HEREIN OR <br /> , NOT. T�E GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OP ANY OTHER <br /> I STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTFIORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORId THE WORK FOR WNICH APPLICAT�ON IS MADE AND I COMPLY WITH THE STATF <br /> ' CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> ' ���,::--; ;��ti._ f�- �y-D�l <br /> SignaWr o�0 eNC mra ior/Authonzed Agent ale <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED �2 <br />