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i <br /> �� a <br /> PERMIT APPLIGATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.� P RMi7 m <br /> 3 �. 3 � Pro c� o� `F373B79al000 � (.�VI ` �� <br /> LEGA LOTNO. B OCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE��__ <br /> G4M✓ + �y0(oPi ,.cs LLC L717 Qocl�li< (l✓ C.vtwFF �- LIL– Li16 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> $�9a�iu�n Gt.�'��� S-fcv� PLe� 1. Y23= 77L - g $ 33- <br /> CONTRACTOR ADDRESS Z!P CONTR.LICENSE/ <br /> a�rrr Nto�v Co 7yoo N,Fr�iSu�. KO <br /> l3��.�, �.�e � 7� .,. <br /> PHONE [�2S ' 7�� .. � 835 £vcr�� (...� 5yzo ; <br /> PROPOSED USE OF BUILDING f� Building Mechanical I� Addition HEAT SOURCE - <br /> PERMIT K Combinalion Plumbing WORK �_�`iteration �"Eiectnc � <br /> r^��q;( TYpE �__( Demolition ign TYPE r��rvew C� Gas <br /> U Sprinkler U Repair/Mainl. U Olher <br /> CONTFtACT PRICE OF WORK r 3 S`!O, o o CITY OF EVERETf LOCAL SALES TA7C CODE IS 3705 <br /> W�RK DESCRIPTION � ��C e S �5�/ <br /> /.t�5a? C C C/� <br /> PLV`781NG MECHANICAL <br /> NO. T'YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM i <br /> WATER CLOSET(TOILET) _ A�C–A/HANDLING UNITS i <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHE? _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLAC[ <br /> FLOOR DRAI�J _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(�cnVICE/BAR/MOP/ETC.) _ EXHAUSI'FAN <br /> OTHER _ OTHER <br /> I — <br /> i HEREBY CERITIFY'"NAT I HAVE READ AND EXAMINE�THIS APPLICATIOIJ AND KNOW THE SA�tE TO BE TRUE AND COf2RECT. 4LL <br /> PROVISIONS OF LAW3 AND ORIDINACES GOVERNING `HIS NPE OF WORK WILL BE COMPLIED:NITH WHETHER SPECIFIEp HEF.EIN OR , <br /> NOT. THE GRANTING C`F A PERId1T DOES NOT PRESUA4E TO GIVE AUTHORITY TO VIOLPTE OR CANCEL THE PROVISION OF ANY OTHER <br /> ISTATE OR LOCAL LAW KEGU�ATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> . OWNER OF THIS PROPEfiTY�i J PERFORh4 THE WORK FOR WH'f,H APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> I CONTRACTORS lAW 18.27�W AND _ W � <br /> i <br /> I Signaw��Ov.. /ContractorlAuthonzed Agent Date �/� I <br /> � DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED i <br />