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P�2MIT APPLICATI�I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857 �`(n `0� <br /> l <br /> SITE ADDRESS PARCEL TAX I.D.� PERyyT�• <br /> /�09 /��r��Tl s«`f. =✓£RZfr ooy3-91�-b�o - I(ob ��4��" <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. � � i I'L �a�i �� � q.17 <br /> OWNER ADDRESS LP PHONE <br /> 5�10-KrN�, iNY�srnAEvr� 11C, l9q,2o�lwy q9�� �v.vivN�1D Wi�.4�'� �-'�/8� <br /> TENANTNAME CONTACT ORPERM PHONE <br /> � �✓�A- /',/6tis ��//1�'.4c�c 6,0�� �'ir .s+�er-�L� <br /> CONTRACTOR ADORESS ZIP CONTR.LlCENSEN <br /> ���G ��v o►�2,/�ua� <br /> PHO _ �`�� <br /> PROPOSED USE OF BUILDING Building � Mechanical I �itlon HEAT�CE <br /> ���,��� PERMIT Combination Plumbing WORK PJteratlon EkcMc <br /> TYPE Demalition Sign TYPE New Gas <br /> �_ � !.iG` Sprinkler Repair/Maint. Other <br /> LJv <br /> CONTRACT PRICE OF WOR 2 �� �� CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> WORK DESCRIPTION <br /> /l,an��nr rvs,��T���/ �i1 wQLL <br /> PL M81NG MECHANI <br /> N0. TYPE OF FIXTURE OR�TEM NO. TYPE OF FDCTURE OR ITE <br /> WATER CLOSET(TOILET) _ AIC—AIHANDLING U S <br /> BA'�4TUB FORCED AIR SYST S <br /> LAV. TORY(WASH BASIN) _ HEAT PUMP <br /> SHO !ER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL � CLOTHES DR R <br /> DISHWASHER RANGE HO <br /> LAUNDRY TRAY �. WATER H TER <br /> CLOTHES WASHER METAL EPLACE/STOVE <br /> URINAL FIREP CE INSERT <br /> DRINKING FOUNTAIN GAS IREPLACE <br /> FLOOR DRAIN G RANGE <br /> BACKFLOW PREVENTER S PIPING <br /> SINK(SERVICE/BARIMOP/ETC.) HAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAA7INED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAINS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WMETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM1IE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OP ANY OTHER <br /> STATE OR LOCAL LAW REG LATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS P PER PERFORM TNE WORK FOR WIiICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOR W 1 7 CW AND 296200 WAC. <br /> Signature o ner/ ontractorlAuthonze gent � �a�O , ly <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />