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Per2MIT APPLICATI� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> ��� <br /> SITE ADDRESS PARCEL TAX I.D.p �PERMiT# <br /> G 0 �� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORE£G 21P PHONE I <br /> r�}o�run. �c,�ter �l�� 2719 r2oc�CcFalla,r a✓�• q82v1 ��fZr151�- i�bl <br /> TENANT N 4ME CONTACT FOR PERMIT PriONE <br /> ta�W� �^ I�G Q�� I 17x� P+ ti 2. - DIZ4 <br /> CONTRAI:?OR Wb�'� N.� � M� JJnt• ADDRESS D g� ��I� ZIP CONTR.LICENSE K <br /> PHONE � F� 'IPZ�L �W���uOZ'lOi <br /> ��Zy� 38�'- Dl2y <br /> PROPOSED USE OF BUILDING �B�ilding fl Mechanical Addition HEAT SOURCE <br /> PERMIT Combination E_� Plumbing WORK �Alteration D Eledric <br /> TYPE Demoliti0n LJ Sign 'fYPE New U Gas <br /> n � !J � Sprinkler Repair/Maint. U Other <br /> ��(L <br /> CONTRACT PRICE OF WORK '�/ � CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> � �' �` <br /> WORK OESCRIPTION ;i /A6Wl' (ur++� '� �'� *� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIxTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C—A/HANDLING UNITS <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 /> LAUNDRYTRAY _ WATERHEP�TER <br /> CLUTHES WASHER _ METAL FIR�PLACE/STOVE <br /> URINAL �IREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIRE?LACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I <br /> jI HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COf2REC7. ALL <br /> PROVISIONS OF V+WS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTNER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BY TNE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 10.27 RCW AND 295.200 WAC. <br /> �p�� �..�' q/N cu <br /> Signaturo o wner/Con`t actor/Aulhonzed Agent ate <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED ��� <br />