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Jun 04 13 11:30a P z <br /> t <br /> PERMIT APPLICATION G _s -i3 <br /> CITY OF EVERETT PERMIT SERVIGES <br /> 3200 CE�AR STREET, EVERETT, WA 98201 <br /> 425-257-88'!0— FAX 425-257-8857 <br /> SITE AODRESS PARCEL TAX I.D.# PERIWIT� <br /> I �-f 0-1 �rU Gil,tWQ,c. Nl�'x'>�r- � <br /> L'eGl. L07 NO. BLOCK TRACT <br /> DESC. <br /> OVlNER AODRE55 21P PHONE <br /> / <br /> �onY Po�r� i u.�,r�w(a � y.o-► P�-vadu�a,�-� ��ao i uas -��9-ys�ti <br /> TENANT NFUdE CONTACT FOR PERUIT PHONE <br /> I J a s� ►� �' I �rd5�v►n �fd-S - 335 - L{D�g � <br /> CpN�'�ps� ADDRESS {M� LP�`��NTR.LICENSE# <br /> Y� v � �; N eafc v�Jc �-�q.��-s�.,� , ,�s <br /> PHONE L�� I'� g�'�'� YJ ✓��� � � DSTI/�1��-i <br /> PROPOSED USE OF 8I11LDING n BUilding A10Ch0tliCal 1 n AdCiCon � HEAT 5 RCE <br /> � PERMIT �-� Comhinalbn Plumbing IWORK rsfplWratlon I Elecc�c <br /> TYPE {{ �8moiition Sign TYPE K Now � Gas <br /> LJ Spnnkler Ll RepairA:alnL � . Other <br /> CONTRACT PRICE OF WORK � ag(p 0�-' I CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WDRK OESCRIPTIOh / ( l� Q�� '�Vl� �f�-I`YIGL C l. V l�� �a �'�'n�✓�i <br /> l.r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTIJRE OR ITEM NO.. TYPE OF FIXTURE OR ITEM11 <br /> N'ATER CLOSET(TOILEt� C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> Lr1VATORY(WASH BASIN) _ HEAT PUi\4P ' <br /> SHOWER UNIT HEATERS <br /> KITCH=N SINK&DISPOSAL CLOTHES ORYER <br /> DISHWASHER RANGE HOO� <br /> LAUNL'RYTRAY _ WAT=RHEATER <br /> CLOTHES WASHER METAL FIREPIACE/STOV'c <br /> 11RI�AL FIREPLACE INSERT <br /> DRINKING FOUN7AIN GAS FIREPLACE <br /> FLOOR ORAIN GAS Rr�NG� <br /> BACKr"LOW PRE1lENT'eR GAS PIPING <br /> SINK(SERVICEI2ARIMOPIETC.) _ EXNAUSTFAN <br /> OTHER OTH[R <br /> I HFAEBY CERITIF`.�THAT I HHL'E REA�7 AND EXAMINEDTHIS APPLICATION ANO KNOYJ TnE SAMc TO 8E TRUc AND CORRECT. ALL <br /> ' ?ROVISIONS OF L+.WS AND ORIJINACES GOVHRNING THIS.T'PE OF WORK'NI�L BE COh7FLIEO bYITH 1NHETHER SP'cCIFIEO 1-ERc1N OR <br /> '�70T. THE GRANTiNG OF A PER.`dIT COC-S NOT PRESUA1E TO GI1'E AUTHCRIT'TO VIOLATE OR CANCEL THE?ROVISION OF M'Y OTr+ER <br /> STA�OR LOCA�lA\Y R'cGUTATI,YG CCNSTRUCTION OR THc PHRFORM1IANCE OP CONS-FUC710N. THAT I Ald AUTHOFIZED BY THE <br /> OWNER OF THIS FRCPERTY TO PERFORh1 THE WORK FOR WHICH APPUCATIOY IS 1.tADG ANO I COMPLY WITH THE STATE <br /> CONT CTORS LAW t 6.2T RCW ANO 295.200 WAC. <br /> ' ��� (�- y -� 3 <br /> 5'na re of wneNContractodHuthorized Agent Date <br /> DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />