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PE:RMIT APPLICATIOi� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS �(�(�l�}'PGh G(�� � PARCEL TA/XJ�I.D.# PERMIT tt <br /> / ,��� l CN Z C/V�lJl.0 30� C�O�D7 `Ot'J4 <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ' �� f AD RESS ZIP PHONE <br /> ��1_ y \ /-��rr� yYlld7���Yl+�u,� ��zi� �-v�tqj�Pe.n t�y ��z�� <br /> . � <br /> TENANTNAME I CONTACTFORPERMIT PHONE" <br /> � -�����,� ��;���� yzs 3sv ����' <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> PHONE �I���pjv <br /> PROPOSED USE OF BUILDING Building Mechanica� Addition HEAT SOURCE <br /> �// PERMIT Combination �R1 Plumbing WORK RI--( A�te2ticn Electric <br /> ,��/�,,p TVPE Demolition U Sign 'iYPE �j Ne�.v � Gas <br /> � <br /> /y/�t�� Sprinkler L! RepaidMaint. Other <br /> CONTRACT PRICE OF WORI ��I �G n P1 CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> dy <br /> WORK�ESCRIPTION � ' <br /> �,r��,��. 9 r���� -� =����.�, ��� ���� <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 HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOUD <br /> _ LAUNDRYTRAY � WATERHEATER <br /> CLOTHES WASNER METAL FIREPLACE/STOVF_ <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> � FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> I � 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 AIJD CORRECT. ALL <br /> PRUVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WNeTHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTNORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGU;ATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS FROPERTY TO PERFORM THc WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW�8.27 RCW AND 296.200 WAC. <br /> /,\�� �<��� ���-� �-� — O' <br /> �ignature of OwnedContractor/Authorized Aoent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED y2 <br />