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P�RMIT APPLICATIC�N <br /> ritY t7F EVERcTT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> I,.� � °`�03"° <br /> LEGAL LOT NO. BL CK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> 1 <br /> TENANT NAM CONTACT FOR P RMIT PHONE <br /> R�,��. �� ��A ���� ��g��� � <br /> GONT CTOR ADDRESS ZIP CONTR.LICENSE# <br /> C��i- r�le�..�..��� l�a3o �. �l-.s�.,k�,.�,�n �8c�a c.�Fom� o�s�✓� <br /> PHONE <br /> 43S1?5"I- 9 Byo c,( <br /> PROPOSED USE OF 9UILDING pERMIT I—S Sprinkllealion 'U Plumbingal WORK K Repa r/Maint, HEAT SE eRV c <br /> TYPE U Demolition U Sign TYPE U New � 0 her <br /> CONTRACT PRICE OF WORK S/ nO �� CITf OF EVERET�LOCAL SALES TAX CODE IS 3105 <br /> W <br /> WORK DESCRIPTION . ' <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 SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEA"i cRS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER PnETAL 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.) ,_ EXHAUS F ,,,/� ^ � I, <br /> OTHER � OTHER r� ItY p�� <br /> I HEREBY CERITIFI'THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME 70 BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS.TYPE OF WORK 6VILL BE COMPLIED WITH WHETHER SPcCiF!ED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE 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 /> OWNER OF THIS PROPERTY TO PERFORM'fHE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> Signature of Owner/ContractodAuthonzed Agent Date <br /> DEEiIT& CREDIT CARDS ARE NOT ACCEPTED <br /> . ,.� -..,.._.�_ ,� .......—�.m_..�.-".____._.r---•- �_..__. ..-.,- - , .. - - - � — � - -- -- -.r - -- - <br />