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�-- --- <br /> P�RMI1" APPLI�AYIOrI <br /> CITII 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.p PERMIT a <br /> �92D ,QuG� � 19�c I Poyo3-r>zB' <br /> L�GA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS Z!i PHONE <br /> �` WA�YI1� ��''�- ? ro�.7 d��oS4�c•► c✓�9 �jt �d <br /> TENANT NAME Ha+� CONTACT FOR PERMIT PHONE <br /> � !�a RC� _ AzOt�in S'rm �Lti wr O�n� _ <br /> CONTRACTOR ADDRESS 21P CONTR.LICENSE M <br /> PHONE ,QoD�n/x ,�c��CZ <br /> PROPOSED USE OF BUILDING f7 Building I-J MeChaniCal �Addilion I HEAT SOURCE <br /> PERMIT �� Combinalio:yFyPlumbirv� WORK Alteralion D ElecVic <br /> TYPE �...( Demolition L/ Sign IYPE New D Gas <br /> U Sprinkler RepainMairt. U Other <br /> CONTRACT PRICC OF WORK �1 �j� CITY OF EVERETT LOCAL SALES TAX CODE IS�1J5 <br /> O� / <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. 1 :?E OF FIXTURE OR ITGM NO. TYPE OF FU(TURE OR ITEM <br /> WATER CLOSET(TOILET] _ A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> IAVATORY(WASH 8.4SIN) _ HEAT PUMP <br /> SHOWER _ UNITHtA1ERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TFAY _ WATER HEATER <br /> � � CLOTHES WASHER _, METAL FIREPLACE/STOVE <br /> � URINAL __ FIREPLl�CE INSERT <br /> I DRINKING FOUNTAIN _ GAS FIREPLACE <br /> � FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING ' <br /> I � SINK(SERVIC /BAR/MOPIETC.) EXHAUST FAN <br /> OTHER HA�� SII1�Cl _ OTHER <br /> i _ I <br /> . HEREBV CERITIFV THAT I HAVE READ AND EXAtdINED THIS APPLICATIl1N AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL I <br /> ' PROVISIONS OF tAWS ANC ORIDINACES GOVERNING THIS NPE OF WORK 1NILL BE COMPLIE�WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERM1IIT DOES NOT PRESUIdE 70 GIVE AUTHORITY TO VIOIATE OF CANCEL THE PROVISION OP ANY OTHER i <br /> STATE OR�OCPL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZE�8Y 7HE <br /> � OVJNER OF T'iIS PROPEPTY TO PERFORM THE WORK FOR WH�CH APPLICATION 151�tADE AND I COMPLV\NITH THE STATE <br /> � C� j+�iTOR�e.��RCW AP�'i 296200 W�C. <br /> i � ,i� �i 1 <br /> � �� �'�L'D �/ <br /> S''igne��re of Owner/Contractor/Auihonzed Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED _j <br /> w <br />