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� <br /> ( { <br /> PERMIT APPLICATION <br /> CITY rOF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRE55 %�1 S ��Da��w�ty PARCEL TAX I.D.p PERMIT# <br /> /�vP�e �(" GvA �L'„ :r � 03!/ � a�� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �/ YS��/�U✓CIf��C��Y/S�Sc�/E.r�/S� �7/8 ,8/tO�u.uy fUtil�L�.� ��10/ /�ZS-13z'c� igL <br /> TENANT NAME �� CONTACT FOR PERMIT PHONE <br /> I �L�f'/L �AL D fGi.d S�Z.f.,3S9- 7_ 4 2 s <br /> CONTRACTOR Gt.���«/ l=/����e (:•,�i�,�r�DDRESS s3c/ S�u��i -�r«��AvP ��I�l CONTR.LICENSE N <br /> �o%�/..r�i G'rt s. ,j�,.c 1 �t I Z /2 kr/�.i Av.. <br /> PHONE <br /> PROPOSED USE OF 9UILDING � Building f ,Mechanical Addition I HEAT SOURCE <br /> �•�i�r�/� PERMIT pp Combination � Plumbing WORK � Alteration � Electric <br /> TYPE D Demolition Gt! Sign 7YPE New Gas <br /> U Sprinklef RepaidMaint. Other <br /> CONTRACT PRICE OF WORK �3 ��,n CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> WORK DESCRIPTION f�� ��4// �x� f �,f y �s �fM t <br /> I�1S�CII �t•n�f IGI•' 4,��-JY f.! �fJC !J' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. . TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C–A/HANDLING UNITS <br /> BATH fUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HFAT PUMP <br /> SHOWER UNIT HEATERS <br /> K!TCH[N SINK R DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPL4CE INSERT <br /> DRINKING FOUN'fAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVI�;E/BP.R/MOf'/ETC.) EXHAUST FAN <br /> OTHER OTHEF2 <br /> — � F�rt /:.d/. rT <br /> I HEREBY CERITIFY THA;I HAVE READ AND EXAMINED TF115 APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECI'. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER Sl�ECIFIED hEREIN OR <br /> NOT. THE GRANTING OF A PERP,IIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTA I ING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AU-HORIZE�BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. � <br /> �' �� J � <br /> �-t f! /Yi �i✓.rl�i.t-c... D [� /Ci_ �OG;� <br /> Signature of OwneNContractor/Authonzed Agent Date ��2, <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED � <br />