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PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS� PARCEL TAX I.D.# PERh x � <br /> �`f� 'f/� ��k� ('�e� ���� <br /> �EGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS / Z!P PHONE <br /> ���cF�,�. ���� .A �u���cH wv.� (=�efe.�t 3Go-qz�{ -�32� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> (�,�e ��� I Q,11 C.i�.��� 3G�- Yz�--�3 2s <br /> CONTRACTOR ADDRESS ZIP CONTR. LICENSE# <br /> �v1cY..�(-5��4 -f ���zt��kw� 2C�� H�+�' �� s��f� �E3z�3 r�et�!'SN�3 �QE <br /> PHONE �/1�UU�^ 1 �/"�P�^v H G..J� <br /> PROPOSED USE OF BUILDING Building � Mechanical Addilion HEAT SOURCE <br /> PERMIT � Combinati0n Plumbing WORK Alteretion � Electnc <br /> 7YPe Demolition Sign T��E Nev� Gas <br /> ��ilc>. S�U�'C Sprinkler RepaidMainL Olher <br /> l <br /> CONTRACT PRICE OF WORK /� /�//) CIIY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> T r.ji <br /> WORK DESCRIPTION I <br /> ,��tk.�,( I �.vu�U� 5��`1 � I /iw��,�J - cl�t�^nc�-e ���c�s �'.,� ��ale 5� �1 � <br /> �J � <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 /> BATHTUB FORCED AIR SYSTEtv1S <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK& 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 FtANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER _ OTHER I <br /> — � <br /> — i <br /> — — i <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE A�D CORRECT. ALL I <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHc?HER SPECIFIED HEREIN OR I <br /> NOT. THE GRANTING OF A PERMI7 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE UR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PER�ORM THE WORK FOR WNICH APPLICATION IS M11ADE AND I COMPLY WITH 7HE STATE <br /> I CONTRACTORS LAW 18.27 RC V AND 296200 WAC. � <br /> U�� /� �-l�Z� �� <br /> SignaWre of Owner/Con actodAuthorized Agent Date � <br /> t <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />