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.r <br /> ` �ERMIT APPLICATiJN -� <br /> CITY OF EVERETT PERMIT SERVICES j <br /> 3200 CEDAR S'fREET, EVERETT, WA 98201 ' <br /> 425-257-8810- FAX 425-257-8857 I <br /> I <br /> SITE ADDRESS PARCEL TAX I.D.M ' PE iT w I <br /> 3�w-P�,NE �v� Goy.3 a D¢-o�� <br /> LEGA 17 IY 15 Zo�'�-�,12f BLOCK TRACT <br /> DESC. ) J ) �� <br /> OWNER ADDRESS LP PMONE <br /> ('�/Aui,t �l��ficr b333 - Ki�l (:�«�rSE . Jly„�;A , � 9bs�t <br /> TENANT NAME CONTACT FOR PdRMR PFiONE <br /> �dk8u� ��-'r� I �oa �ofLT 4tS-�3876Zf <br /> CONTRACTOR AODRESS aP CONTR.UCENSEN <br /> � <br /> PHONE <br /> PROPOSED USE OF BUILDING Building D Mechanical Addition ( HEAT SOURCE <br /> DA�wTgA�l 6�hK PERMIT R Combination B Pl9mbing WORK R Alteration D Electnc <br /> 1 TYPE D �emolition Si n 7YPE ❑ New D Gas <br /> U Sprinkler U Repair/Maint. U Other <br /> CONTRACT NRICE OF WORK CITY OF EVERETT LOCAL SALES TAl(CODE IS 310.5 <br /> WORK DESCRIPTiON <br /> ����t9� �' u.0e� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fl7(TURE OR ITEM N0. TVPE OF Fl7CTUAE OR REM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWEF UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACEISTOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> 6ACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I <br /> II HEREBY CERITIFY THAT I HAVE READ AND EXAMINE�THIS APPLICATION AND KNOW THE SPME�Q BE TRUE.IND CORRECT. ALL �, <br /> PROVISIONS OF LAWS AND ORIDIiVACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED v..:li WHEfHER SPECIFIED HEREIN OR <br /> NOT. TNE GRANTING OF A PERMIT�OES NOT PRESUM�TO GIVE AUTHORIIY TO VIOIATE OF CANCEL TME PROVISION OF ANY OTHER <br /> STATE OFi LOCAL lAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTIGN. THAT I AM AUTHCRIZED BV TTiE <br /> OWNER OF THIS OPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOR U1 18.27 RCW AND 2P6.200 WP , <br /> � , .,/ ��03 � <br /> r <br /> Sign e oi OwnedContractonAuthonzed Agent ate �IL I <br /> i DEBIT & CREDfT CARDS ARE NOT ACCEPTED I <br />