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P�RMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> E ADDRESS PARCEL TAX I.D.p PERMi7 p <br /> /2 - ��1A%' !ZD o0 3 - rx�o -ac�Z- CG3a5 -03� <br /> LEGA LOT N0. yL BLOCK TRACT <br /> OW ER A p��/C �.0(���Q�� � . <br /> ���T'��' / `''i�ir�i��'�`,�y yz3� - S� 3� LIP PHON zS0 'IZI� <br /> TENANTNAME � �� <br /> CONTACT FOR PERMIT PHONE <br /> �— '�_ � <br /> CONTRACTOR AUDRESS <br /> P�(JL �(J��,�{'�'�y(,�_��-LQ�L ZIP CONTR.LICEN9E N <br /> PHONE ' �?S ZSp ' ��,�� ��P � �� <br /> PROPOSEL USE OF BUILDING � Buflding PS Mechanical }� Additlon HEAT SOURCE <br /> PERMIT Combinatlon �� P�umbing WORK ❑ Alteratlon �Elactric <br /> t ,1,J�, /�� TYPE Demolillon LJ Sign TYPE D New Gas <br /> 71�{7�.� MIL"� Ic.GS, Spnnkler U RepaldMalnl. Other <br /> CONTRACT PRICE OF WORK C�TY OF EVERETT LOCAL SALES TAX CODE IS]103 <br /> WORK DESCRIPTION <br /> �'�G'r'E��Uh - /ZL'/7-u2�.�� <br /> NFJN BASE 6rsT 4�4nA�6 vti►Gfcrz IEx�ST/n/4 ffouS'E <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%NRE OR ITEM <br /> _ WATER CLOSET(TOILET) // A1C—AIHANDLING UNITS <br /> _ BATHTUB � FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) J,!� HEAT PUMP <br /> _ SHOWER / UNIT HEATF.RS <br /> _ KITCHEN SINK& DISPOSAL CLOTHES iJRYER <br /> _ DISHWASHER RANGE Ii00D <br /> _ LAUNDRY TRAY _� WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> __ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DR,41N GAS RANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER OTHER <br /> i HEREBY CERITIFV THAT i HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WURK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERM1IIT DOES NOT PRESUh1E TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGU ING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTMORIZED BY THE <br /> OWNER OF THIS PROPER PFRF6R�T WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH TME STATE <br /> CONTRACTOR 1B. RCW}l}JD AC. <br /> �� � � 23� � <br /> SignaWre of OwneNContractor/Aut onzed Agent ate � <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED � <br /> I - <br />