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;�� PE�r�MIT APPLICATION <br /> o 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.# PERMIT R , <br /> 5��5 S L�dE=�1r2Ec-7V �,:� �'�`l0 -�l <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> TENANTNAME CONTACTFORPERMIT PNONE <br /> ��'LCL[S�OiV �O/�!s/O ,� (GNA•2/� �/� � �H �u S/00�3S1 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> (Z- T hlfJO �'J d ,CIU�T $VLS 6/00 /2 TH f,t-!/S' S S�TlGE 9' O� <br /> PHONE ZQ � 7 Z� O � ��G <br /> 2 T/z'o o� �-o ��Q L <br /> PROPOSED USE OF BUILDING BUilding n Mechanical Addllion HEATSOURCE <br /> PERMIT � Combination �'"} Plumbing WORK R Alterelion D Electric <br /> �U�-� 2C�� � 2 TYPE Demolition � Sign TYPE R New Gas <br /> Sprinkler V Repair/Maint. B Olher <br /> CONTRACT PRICE OF WORK Z�� G� CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION �N 5—��( O�� Cf.�E-i�. r c,¢�_ �i�E <br /> vICJP/�/ZES_SIDN �ni ��-�.v �- Boc� �`-�r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) AIC—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLGTHES 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/BAWMO�/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 AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GUVERNING THIS TYPE OF WORK WILL BE COtdPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 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 /> CONT�D�Ci�RS LA 1B. AND 6.200 WAC. <br /> UL 9-�6-a u <br /> Signature of OwnedContractodAulhorized gent Date � <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED 1 L <br />