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1 <br /> PE�MIT APPLICATION <br /> CI i Y 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.R PERMIT u <br /> Se19 -000 -oB3 -oto9 Q / / - ��-� <br /> '�19! <br /> LEGA LOT NO. BLOCK TRACT W <br /> DESC. � , J��K.v�£l2. � ���N -' <br /> OWNER ADDRESS ZIP P ONE <br /> �uFJ�a'`^^�o�.r�C.�'C �ti.t7H.\�S�v✓vQn.�� �PD'(a . <br /> TENANT NAME CONTACT N}1ME PHONE <br /> �'tRT �aC.�GS �-n.� . I �A2�1 PIE�.Jmw,1 2�b� 903 -82�y £xT.szzc <br /> CONTRACTOH ADORESS ZIP CONTR.LICENSE M <br /> �11h�t,JtiTF_ 'f�l� CO ZI.SG• �2l-11�-( 1.�IuJh�t0.q 5 . �'+ 20 �.Vt�C'.EfC�ln�• <br /> PHONE ���y <br /> L'�/ZS�.-1 23 -q"r 1.�3 <br /> PROPOSED U,E OF BUILDING �f Buildittg Mechanicai Addition HEAT SOUFiCE•-C+nm.lL <br /> PEFMIT n Combination R�( Plumbing WOaK nitere�ion R E�ectric <br /> ��"�PF��� TYpE K Demolition U Sigh TYPE New �j Gas <br /> ��z� -g'�o p LJ Sprinklef Repair/MainL U Other <br /> \ <br /> CONTRACT PRICE OF WORK� �Q�� ,^� CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCFIPTION <br /> T� sT�.�.. ,�c�,a sra�,�� ���z�r��uT noo�z � d�s��.,���1 Cs�. d�,�;��'� <br /> ,O C�A.ZC.� N � S�O�S"`�tOv: � <br /> — PLUMBING � MECHANICAL /� <br /> NO. TYPE CF FI;CTURE OR ITEM � NO. I TYPE OF PIXTURE OR ITEM � ^� <br /> WATERCI.OS�T _ A/C-A/HANDLINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATEFS <br /> ^ KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br />� CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DR�NKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS FANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER_ <br /> I HEREBY CEAITIFY'HAT I HAVE READ AND E%AMiNED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PFOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COPAPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORIh'TO VIOIATE Oq CANCEL THE PROVISION OF ANY OTHER <br /> STA7E OA LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> O\NNER OF THIS PROPERTY TO PERFORM 7HE WORK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> C4NTRACTOR�J.AW 1027 RCW APlD 296.200 WAC. <br /> t�' �us G rrl �R�n1 <br /> Si �alure o� nedCoNractor/Au�honzed Agent Date � <br /> \ <br /> i <br /> J <br />