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_ -- - i <br /> ! PERMIT APPLICATIdN 'i <br /> CITY OF EVERETT PERMIT SERVICES ' <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 � <br /> I I� SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �-2?� ��.,._S� �1 '` ��� -U1� � <br /> LEGAL �OT NO. BLOCK TRACT <br /> DESQ I <br /> OWNER ADDRESS ZIP PHONE �ZS - 3yF�_ <br /> I' �„ �-}2cr.1e Zz 3o q-dv�..�s 1}�,e E�'F"r � Ft�3 �z�t <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> I <br /> ���<` I <br /> CONTRACTOR ADDRESS . ZIP CONTR.LICENSE# ��� <br /> II <br /> PHONE ��µ � . <br /> I, <br /> PROPOSED USE OF BUILDING f7 Building p�+,.�( Mechanical Addition HEA7 SOURCE <br /> PERMIT ,� Combination �) Plumbing WORK � Alteration � ElecVic <br /> �,�R����� TYPE I--1 DemoliHon U Sign TYPE New Gas <br /> �� Sprinkler Repair/Maint Other <br /> CONTRACT PRICE OF WORK CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 I <br /> WORK DESCRIPTION � <br /> I PWMBING MECHANICAL <br /> j NO. I NPE OF FIXTURE OR ITEM � NO. TYPE OF FIXTURE OR ITEM . <br /> I WATER CLOSET(TOILET) _ A/C—A/HANDLING UNITS I; <br /> BATHTUB FORCED AIR SYSTEMS I� <br /> LAVHTORY(WASH BASIN) HEAT PUMP I <br /> � SHOWER t�/ UNITHEATERS I <br /> KITCHEN SINK 3 DISPOSAL _ CLOTHES DRYF_R i <br /> — RANGEHOOD <br /> _� DISHWASHER <br /> �t LAUNDRYTRAY _ WATERNEATER ; <br /> CLOTHES WASHER _ METAL FIREPIACE/STOVE <br /> URINAL � _ FIREPLACE WSERT I <br /> DRINKING FOUNTAIN _ GAS FIREPLACE i <br /> � � FLOOR DR4W � GAS RANGE <br /> BACKFLOW PREVENTER 'L GAS PIPING I <br /> ��i SINK(SERVICE/BAR,'MOP,�ETC.) EXHAUST FAN <br /> OTHER �, OTHER k��R G1�-�- ,. <br /> �N',j _ SYV C2S '. <br /> �-. t#3 .— �. <br /> =I _ <br /> ' '. HEREBV CERITIF"'HAT I HAVE READ AND EXAMWED THiS APPLICATION AND KNOW THE SAM�TO BE TRUE ANp CORRECT. ALL ' <br /> PROVISIONS OF LAWS AND ORIDINACES�30VERNING THIS TVPE OF WORK WILL BE COMPLiED WITH WHETHcR SPECIFIED HEREIN OR �. <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCcL THE PROVISION OF ANY OTHER ', <br /> � STATE OR LOCAL��A`N REGULATING CONSTRUCTION OR THE PERFORMANCE OF CON�STRUCTION. THAT I AM AU?HORIZED 8Y THE <br /> '� OVJNER OF THIS?ROPERTV TO�ERFORM THE WORK fOR WHICH APP�ICATION IS bSAJE AND I COMPLY WITH THE STATE <br /> ' CUNTRACTORS LA'JJ 1827 RCW aN0 296200 WAC. , <br /> n i <br /> �� —'} �1,. _ If / � � � <br /> __.l t...,..� !""c-/.a..�"_ , '� <br /> II Signature of OwneriContractodAuthonzed Agent Date <br /> ' DEBIT & CREDIT CARDS ARE NOT ACCEPTED _ <br />