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PERMIT APPLICATION � <br /> CITY OF EVERETT PERMiT SERVICES <br /> �� ��,—� 3200 CEDAR STREET, EVERETT, WA 98201 �`(/'9�-OZ� <br /> ; - z� � <br /> 425-257-8810- FAX 425-257-8857 <br /> �a/'s�J <br /> SITE ADDRESS PARCEL TAX I.D.# P MI7 n <br /> I��5` ra a S7 4¢ �dYa3-o�f z <br /> LEGA LO'lNO. BLO TRACT <br /> DESC. <br /> OWNER DRESS ZIP PHON - <br /> � t R¢f�V�:�YO� 3�o'TO�IJ� ,¢�CG ITfL71l�p�4Llr P zo6 <br /> �C1i2�uf 3� t�OlOir�rAS �E Sfc 3'DO Seaffle u/�i 98/D/ <br /> TENANT N E ' CONTACT FOR PERMIT ��-� PHONE <br /> �(� C/31 ') 7 1 7 <br /> � �i-��mv p�J 1�P,+t�. �G�Yc-reS Zfib -6 2'SG� <br /> CONTRACTOR Ql��p G ��(( ADDRESS �lfj GL(,µclLY ZIP C NiR.LICENSEA <br /> ���r Muk�l�D� G//�' �SZ7S P��OI� <br /> PHONE C¢Ti�7J SDT/ `�O` / � 1 � <br /> PROPOSED USE OF BUILDING Building I"') Mechanfcal Additlon �E�T SOURCE <br /> PERMIT Combination �_� Plumbing WORK �PJteration � IncVic <br /> TYPE Demolilion LJ Sign TYPE New Gas <br /> Sprinkler RepaidMainl. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION NP�� S�Pi'� ,F�GG(b �Ii1� <br /> ;`�.��-�- �Ef�� 03'OS9 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXNRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C—AIHANDLING UNITS <br /> BATHTUB �ORCED A!R SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&D'SPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRIP•1K�NG FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/E'i"C.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICPTION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUL�ITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH AFPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> ���5-' � �—��< � 3- / 7-v <br /> Sig ature of OwnedConlractor Authonzed Agent Date �a <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />