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1 <br /> P�ttMIT APPLICATIOIV � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREEti-, EVERETT.WA 98201 <br /> 425-257-8810- FAX 425-257-8857 I <br /> pARCEL TAX I.D.# PERMi7 u I <br /> SITE ADDRE!SS � I �O�'p� .�^�C{ <br /> ��31 3<<�dU,a� Cz7��c�o� ,000�a .,.. � <br /> LEGA lGTNO. BLOGK TRACT <br /> DESC. Z�p pHONE <br /> OWNER AODRESS <br /> � � �� uG �11-1 �ZcX�4 M�P✓ �1U–f-- ��� � �� ' Z�Z'�21U <br /> � ,1���I'1 C�_ PMONE <br /> TENAfIT NAME I CONTACT FOR PERMIT <br /> ��.le l�d 4�d (�12s) �v s' - 3m� <br /> CONTRACTOR ��1��p�� �,� .C�„kn�1-ah <br /> ADDRESS p� Q�X �',,1�'� Z�P CONTR.LICENSEN <br /> `i�eidl-, wA `16'ZD� Ol t'n,�06G �1�5 P? <br /> PHONE IIZS -�-�1�j"1�lla 1 <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> Q Elecrtic <br /> � PERMIT �Combination u Plumbing WORK Alteration � Gas <br /> 1YPE Demolition L� Sign TYPE New <br /> Sprinkler <br /> Repalr/Maint. Other <br /> CITY OF EVERETT LOGAL SALES TAX CODE IS 3105 <br /> CONTRACT PRICE OF WOkK <br /> WORK DESCRIPTION i <br /> �m� 04� e'X��t��j SF�`s G�d ��jo ;� ;�5 `,��P 1�:��(���SS <br /> PIUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C–AIHANQLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> � UNIT HEAT[RS <br /> SHOWER CLOTHES DRYER <br /> KITCHEN SINK&DISPOSAL —� RqNGE HOOD <br /> DISHWASHER =) WATER HEATER <br /> LAUNDRY TRAY i.tE.(AL FIREPLACE/STOVE <br /> CLOTHES WASHER — FIREPLACE INSERT <br /> URINAL GAS FIREPLACE <br /> DRINKING FOUNTAIN — GAS RANGE <br /> FLOOR DRAIN GAS PIPING <br /> BACKFLOW PREVENTER — EXHAUST FAN <br /> SINK(SERVICE/BAR/MU�/ETC.) — OTHER <br /> OTHER — <br /> I — — <br /> I — <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH INHETHER SPECIFIED HEREIN OR <br /> STOATE OR LOCALILAW R GULATING C�ONS RUCTIOM OR T�HE PERFORMANCE OF CO STRUOCT ONNC HAT AM AUTHIORI ED By�TE ER <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR\NHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONTRACTORS LAW'18.27 RC\N AND 296.200 WAC. <br /> �-L�e�/e�� �...�.� l0 �L��.r <br /> Signature oi�W�edConlreciodAuthonzed Agert Da��— <br /> , DEBIT 8� CREDIT CARDS ARE NOT ACCEP4ED � <br /> � <br />