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P�RMIT APPLIC:ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEREiT, WA 98201 <br /> 425-257-8810 — FAX 425-257-885'7 <br /> SITE ADDRISSS I PARCEL TAX I.D. # I PE�iT aD� `v1� <br /> � ��1 �����/1 �E � � �-i <br /> LEGA LOTNO. BLOCK TRP.CT <br /> oEs�. 5 3�� <br /> OWNER ADDRESS 21P PHON J�5 <br /> I�N�SSr� ��-4�-e. I � ll 3�4-1��2 �+✓� %gdo! 33y. G/GO <br /> TENANT HAME I CONTACT FOR PERMIT PHOME <br /> S�-m �e <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> PHONE ��1.� �/ �/1_ <br /> PROPOSED USE OF BIIILDING Building � Mechanical Addition I HEAT SOURCE <br /> GAe�y`�- PERMIT RI-( Combinalion Plumbinc� WORK R{-1 Alleration R Elecvic <br /> I TYPE �...j Demolition Sign TYPE � New �..j Gas <br /> U Sprinkler J�BepairlMaint. LJ Other <br /> CONTFiACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORN DESCRIPTION n���; <br /> �o�(� 4�wm/�a� �Y�/'J YY��e2rA-� � (��'i�iN/ - <br /> v J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> WATER CLOSE'1'(TOILET) A/C-A/HANDIING UNITS <br /> 04THTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DP SR <br /> DISHWASHER RANGE H00. <br /> LAUNDRY TR4Y WATER HEA7 <br /> CLOTHES WASHER METAL FIREPi :E/STOVE <br /> URINAL FIREPLACEINSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIP�NG <br /> SINK(SER`/ICE/BAR/M1tOPIETC.) EXHAUST FAN <br /> OTHER OTHER <br /> — — — <br /> I — — <br /> I — — — <br /> I I HEREOV CERITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIrIED HEREIN OR � <br /> NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br /> I STATE OR LO'CAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OP CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> �� ONlNER 6F,7HIS PROPERTY TOPERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONTRP.�TORS LAW 18.27�C1�OAND 296.:00 WAC. / <br /> � / <br /> � � � �.` 2 / G C) <br /> Sigpatur � wnen onVact � lhonzed Agent ate <br /> V <br /> CEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />