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--- -------'----- ,'� iJ — I.'jJ � <br /> � - - ----- PtRMIT APPLICATIGnI � j� y °J �•""' <br /> �I CITY OF EVERETT PERMIT SERVICES 6a <br /> %/=f C <br /> 3200 CEDAR STREET, EVERETT, WA 98201 /P y.l�'�l/•[e f 3�►�6ou <br /> 425-257-8810 — FAX 425-257-8857 <br /> iSITE ADDRESS / /� PARCEL TAX I.D.# PERAtiT a <br /> I Q1�, ��/< • h_- C�� Q�.li�`f %j g12Qo �M � -oo � <br /> I LfGAL LOTNO. BLOCH T ACT � /1 /� 7� <br /> ; DESC. , � P" �L I �/ /J�� //� OU <br /> O --, <br /> OWNER AD RESS ZIP PNONE <br /> ��,C���.— ����.� �3�k�,-A� r-��.� 98�i uzs�-1s�-��'�� <br /> TENANT NAME �,�CONT/�CT FOR PERMIT PHONE <br /> �/ (JohtiG,G.��-- y15�-Zs z -CS7 a <br /> CON�RADDRESS ZIP CONTR.LICENSE M <br /> PHONE <br /> �,J,t:.^�--- <br /> PROPOSED USE OF BUILDING � Building D Mechanical I Addilion HEAT SOURCE <br /> PERMIT COmbination U Plumbing �WORK � Alteration � Eiectnc <br /> TYpE Demolil�on U Siyn ITYPE New Gas <br /> , �^ �"' Sprinklef RepaidMaint. Other <br /> ` _' ' � <br /> CONTRACT ICE OF WORK CIiV OF EVER[TT LOCAL SALES TAX COUE IS J105 I <br /> WORK DESCRIPTION �� �L / �^1 I <br /> �. N.T��I/OJi ���Z. YZY e�7✓'l�.Mcf_ ��5c�0 i <br /> / � <br /> PLUPABING NECHANICAL <br /> NO. 7YPE Of FIXTURE OR ITEM NO. TYPE OF FIXTUfcE OR ITEM <br /> WATER CLOSET(TOILET) _ 4/C—A/HANDLII lG UNITS <br /> BATHTUB _ �ORCED AIR SYSTEMS <br /> LAVATORY(I,NPSH OASIN) HEAT PUMP <br /> SHOWER ' UNITHEATER:i <br /> KiTCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> JISHWASHER R4NGE HOOD � <br /> LAUNDRY TRAY N ATER HEATER <br /> � CLOTHES WASHER h1ETAL FIREPi 'F/STOVE <br /> URINAL FIREPLACE IN: ..iiT <br /> DRINKING FOUNTAIN � GAS FIREPLACE <br /> � FLOOR DRAIN � GAS RANGE <br /> ' BACKFL01�' PREVENTER � GAS PIPING <br /> SINK (SERVICEIBARIMOPIETC.) _ EkHAUST FAN <br /> j OTHER _ OTHER <br /> -- _ -- I <br /> i HERF.BY CERiTIFV THAT 1 HAVE PEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AN�CORRECT. ALL <br /> PRGVISIONS OF LAWS AND ORIDINACES GOV[RNING THIS TYPE OF\NORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR I�I <br /> NOT. THE GRANTING OF A FERMIT�OES NOT PR�SUME TO GIVE AUTHORITY TO VIOLATE OR::ANCEL THE PROVISION OF ANV OTHER <br /> STATE OP.LOCAL LAW REGULA�.�ING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WMICri APf LICATION IS MA�E AND I COMP�Y WITH TNE STATE , <br /> CONTRACTORS LAW 1827 RCW ANU 296.200 WAC. I <br /> � Signature of Owner/ContractorlAuthonzed Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> ; ._ <br />