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PtRMIT APPLICATI�N <br /> 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.p I PF,�tMiT p � <br /> /(ciy6,o,% /J�c onrvvvc�� oo �:,� (�D3o7—Da. <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. �o',tG 7 � 4✓<,er+ n,��t <br /> OWNER � ADORESS ZIP PHONE <br /> �r 6✓- vz s-- 7�/v-iC�-/ <br /> \)Nm..r. ,if. lniav,✓ /(i ''� /.YA�c.f7 ,i�..0 S�zf- Z4 7 - SGjy <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS 21P CONTR.LICENSE p <br /> PHONE <br /> PROPOSED USE OF BUILDING Building D MBChdnlCal Additlon HEAT 90URCE <br /> s�u(xL�. FP,NI�-r R�5• PERMIT R CombinaUon U Plumbing WORK � Altera0an � Eleclric <br /> TYPE Df ` Demolitlon U Sign IYPE New Gaa <br /> �j] ✓ Sprinkler Repalr/Malnl. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> WORK DESCRIPTION <br /> r�2�N� -,.� ��,�,: - .1< < e.�.s:� R�titoV�.- NO�1' coniFok.n,�uG, Ae�/T/��r <br /> I� ITg £N71F`7`/. g� l�� A.lEW 6X6' <br /> c l A o �4u�uhk.Y kaom � 6 'X27' STo�c,a4E rauti <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK f:DISPOSAL CLOTHES DPYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLUTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINK!IJG FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICEiBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> � <br /> I I HEREBY CERITIFY THAT I HAVE READ AND EXAh11NED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CJRRECT. ALL <br /> i PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK YJILL BE COMPLIED WI'�H WHETHER SPECIFIED HEHEIN OR <br /> NOT. iHE GRANTING OF A?ERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTIO'J. THAT I AM AUTHORIZED BV THE <br /> ! OWNER OF TH PROPER i V L0 FERFORAI THE WORK FOR WHICH APPLICA710N IS MADE AND I COMPLV W�TH THE STATE <br /> CONTR{tCTO�LAW 78.27��YAND 296.200 WAC. <br /> / <br /> � _ ��i� - � �.� Z'— �- �f �3 <br /> Signa e of OwnedConlractor;Aulhonzed AgeN Date �a <br /> � DEBIT 8 CREDIT CARDS ARE NOT ACCE4'TED <br />