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PrRMIT APPLICATIUN ' <br /> CITY OF EVERETT PERMIT SERVICES ' <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> � <br /> . SITE ADDRESS �O31Q A���6 h Road PARCEL TAX I.D.# PERMI7# I ' <br /> 4.�c�tE, w�l q$a o4 Uc�S 3�6� Do 0o a4 oc� S SU 7- Do � � <br /> LcGA� LOTNO. BLOCK TRACT , <br /> DESC. <br /> OWNER ADORESS ZIP PHONE <br /> � <br /> ��a,rY�r,��1� �-s,2r�t gS�ia ' <br /> �Fit� `zroi�tti � l..l...C. '�,�1 H ��,v�Yl�ool Rc'� N�4 '�!�13 "381 � <br /> � <br /> TENANT NAME C TACT FOR PERMIT H E � <br /> ��'A"`SII����i\d�.� 1�- fo�l..��4'$ ��`+` �<9YSOv� ��fa5 �'1�1 �50�1t� <br /> 9 ri A P o��-A1L 'Oy`t-pl� I <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# I <br /> f��l� Ni�,�,$�c. �t�co t\a��oo�,- S? ac�;Sv15.. ao5S , M„k��\��o �c�a�s <br /> PHONE S c�y ^/���� <br /> C�+3S)3'-l�t ` y <br /> PROPOSED USE OF BUILDING I Building �Echanical Adtlition HEAT SOURCE <br /> � PERMIT R Combination lumbing WORK �Alteratlon � Electnc <br /> TYPE D Demolition Sign TYPE New Gas <br /> I U Sprinkler Repair/Maint Omer � <br /> CONTRACT PRICE OF WORK � a���p� CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> (ZtirnL��, La) i..x�S'ti.v�c� r�ov. \�} s�c�y�s <br /> ���5�-�l " h`i,w l� tl i! <br /> PLUMBING MECHANICAL � <br /> i <br /> NO. I TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM � <br /> i <br /> i <br /> _ WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> ; _ BATHTUB FORCED AIR SYSTEMS <br /> � �aVATORY(WASH BASINI HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> �. ' KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> = IAUNDRY TRAY WATER HEATER I <br /> CLOTHES WASHER METAI�IREPLACE/STOVE <br /> URINAL PIREPL4CE INSERT . <br /> DRINKING FOUNTAW � GAS FIREPLACE �' <br /> FLOOR DRAIN GAS RANGE <br /> �, BACKFLOW PREVENTER GAS PIPING <br /> _I SINK(SERVICE/8AR/MOP/ETC.) � EXHAUST FAN i <br /> �_iOTHER _ OTHER I <br /> — — I <br /> — — <br /> �� eEREB�CERITIFY THAT I MAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL �, <br /> �ROVISIONS OF lA`NS AND ORIDINACES GOVERNWG THIg TYPE OF WORK WILL BE C0�IPLED WITH WHETHER SPECIFIED HEREIN OR li <br /> `�OT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TG VIOLATE OR CANCEL THE PROVISION OF ANY CTHER �,. <br /> �-�Te OR LOCAL_AW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 'HAT I AM AUTHORIZED BV?NE j <br /> C�P;'�ER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE �, <br /> GNTRACTORS LAW 1A27 RCVJ AND 296200 bNAC � � <br /> �c�.,.� �.e�;,� j <br /> Signature of OwneriComra.;t nAuthori�ed Agent Date II <br /> DEB�r & CREDIT CARDS ARE NOT ACCEPTED �a j <br />