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� PERMIT APPLICA'i iON <br /> CITY 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.X PERMIT# <br /> � C�'� � (/� � ��'C7�b <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWN'E/R ADDRESS ZIP PHONE <br /> ! ` <br /> �,�� �, a� ,.� T_ ��vY=Sy n,��,-, TS <br /> TENANT NAME CONTACT FOR PERMIi PHONE <br /> ��C.c �G'tU ( nr'�l ii� �Ct f�� ��cti Y'zs �- S-S' 1 7yL� <br /> CONTRA::TOR ADDRESS ZIP CONTR.LICEHSE• <br /> PHONE <br /> PROPOSED USE OF BUILDING R Building � Mechanical R Addition HEAT SOURCE <br /> I TYPEIT Ll pnnRle�non Si9n bing IrypE V RePairMalnt. I V ONcMc <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%CODE IS�105 <br /> WORK DESCRIPTION <br /> � 0 �� �� .�' C7 I���>y GvIIFtTok- p�aq5 `�-a jcZ �j) � Sar.cJ <br /> � � <br /> � `� YTJ �/a i��tJP,� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXNRE 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 /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES�RYER <br /> DISHWASHER RANGE HOQD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL 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/MOPlETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TFiAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 78.27 RCW AND 296.200 WAC. <br /> � � � I� <br /> �iG�(�`4/ �(lLc�(��l��l�-� �Z- 097J1� <br /> Signature of OwnedContracto/Authorized Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />