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r--- <br /> �CRMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDP R STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857 � <br /> PARCEL TAX I.D.# PERMi7 a �' �� <br /> SITE ADDRESS I g D3 n q-o�a � <br /> 0�0 LbE2 �+''?--c�aoa-18000i _ I <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. �� �qpDR SS P ZIP PHONE <br /> OWNER I <br /> �R,�i�//�C R6/�/ L�'Y �O AL I�E2 S T 9�a3 <br /> TENANTNAME <br /> I CONTACT FOR PERMIT PHONE <br /> rn� ��c S7oU�/b'R 360-��3-�s8v� <br /> ADDRESS ZIP wn�rt.u..c�..,�� <br /> CONTRACTOR �{�'y�t;c;o�l��E <br /> SI'CY R.V GTZ Go,oS%. rNC I <br /> PHONE <br /> 36o- 7q3-9'sF'� /icss flr�R rz�_ sucT.�� �. � a9s� <br /> �au�lding Mechanical 7�Addition HEAT SOURCE <br /> P R O P O S E D U S E O F B U I L O ING �CT� I W O R K�A I t e 2 ti o n � Electnc <br /> �M`LY PERMIT I ) �ombina tion � P tu m b i n g TMPE NeW Gas <br /> �j��(�(� � 7YPE [� Demolition Sign Repair/Maint. .. ��e� <br /> ��51���c LJ Sprinkler <br /> CONTRACT PRICE OF WORK� �� Q�A ."� � �:7 CITY OF EVERETT LOCAL SALES T N(C O D E I S 5 1 0 5 <br /> WORKDESCR�PTION � �Lb NEw �yr�� RapFS F� P>AY W NDoW �S�'�Y <br /> REPLAGE 3 �RONT Cv�N6bWs � LAY A !�EW SNA�' �US rrIE7�AL <br /> �!�V I::. <br /> l��ol= .SYSTtM 4r'�A r_C,✓+�T:;�.-u:45 j2,:6'DE idc r v'7� . (vx �_� <br /> PLUMBING <br /> MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> UNIT HEATERS <br /> SHOWER CLOTHES DRYER <br /> KITCHEN SINK&DISPOSAL — qqNGE HOOD <br /> DISHWASHER ^ WATER HEATER <br /> ^ LAUNDRY TRAY � METAL FIREPLACE/STOVE <br /> � CLOTHES WASHER — FIREPLACE INSERT <br /> URINaL � GAS FIREPLACE <br /> I — DRINKING FOUNTAIN - GAS RANGE <br /> FLOOR DRPIN GAS PIPING <br /> BACKFLOW PREVENTER EXHAUST FAN <br /> I — SINK�SERVICE/BAR/MO?lETC.) — OTHER <br /> OTHER <br /> I —I <br /> i, -� - I <br /> �' I HEREBY CERITIFV THAT I HAVE READ ANC EXAMINEC THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � P40VISIONS OF LA�NS AND ORIDINACcS GOVERNING THIS.TI'PE OF WORK WILL 8E COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF P.PERMIT DOES NOT PRESUME TO GIVE Ai1THORIN TO VIOLAYE OR CANCEL THE PROVISION OF ANY OTHER <br /> '� OWNER OF OHIS PROPERTV OTPER ORM THE WORK FOR WHICH APPLICAYION IS MADERANOTIO OMP L W TH THE SOTATE D BY THE <br /> CON RACTORS LAW 18.27 RCW PND 296200�VAC. � <br /> ' �,u•i/� �-�� `� 1� o ;�. I <br /> Sig ature of OwnedContractodAutho gent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED I <br />