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� r�ERMIT APPLICA� iON <br /> CITY OF EVERETT PERILiIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 �� �� <br /> SITE ADDRES ��ZO� PApCEL TAX I.D.N PERMIT x <br /> � OONOnO -Oo0-03� �o3H.000 <br /> LEGA LOT N0. BLOCK TRACT �.^ 0��� 7 <br /> DESC. 6 p✓ �� <br /> AD RESS ZIP 1'H�NE <br /> �j-bs�c� 8�5, Co�s�. 3`�d�.4�� �'g �,�e Nt E�e�e-+-l- c�o� � �2S-39�- 736J <br /> TENANT NAME CONTACT FOR PERMIT �HONE <br /> No.�ck �c�s, cd�st I �c�e1 Hqc�,ck �i2.5- 2��o-2�Z9 <br /> CONTRACTOR ADDRESC 21P CONTR.LICENSE JI <br /> �-k�c�K f3r�s, c�nSt 3�aa ����,ve . N �. Eve�t�iti�2os �ac�: Bzc�i2C <br /> PNONE�`r �� '� ?6 O <br /> .T J <br /> PROPOSED USE OF BUILDING f� Building Mechanicel Addition HEAT SOURCE <br /> PERMIT �� Combinelion R PWmbing W�RK � Alteration �ElacMc <br /> 1� 1 ��) S F� TYPE fq Demolition D Sign TYPE New Ges <br /> � u U S�nnkler Rapair/Maint. Other <br /> CONTRACT PRICE OF WORK �S�O C)� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTON . <br /> N��--� sF � _ ��c� 2v8� <br /> - PLUMBING MECHANICAL <br /> NO. TYPE OF fl%TURE OR ITEM N0. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDI.ING UNITS <br /> ,i BATHTUB � FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEP.TERS <br /> � KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> � DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> � CLOTHES WASHER _ METAIFIREPLACE/STOVE <br /> UHINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN � GAS FIREPLACE <br /> FLOOR DRAIN � GAS RANGE <br /> BACKFLOW PREVENTER S GAS PIPING <br /> � _ SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> � _ OTHER _ OTHER <br /> � — I <br /> I <br /> I HEPEBV CERITIFV THAT I HAVE HEAD AND EXAMINED THIS APPLICATI�N AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISiONS OF LAWS 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 AUTHORIN TO VIOLATE OR CANCEL THE PROVIS�ON OF ANY OTFIER <br /> � STATE OR LOCAL LAW REGULP.TING CONSTHUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> � OWNEF OF THIS PROPERIY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> � CON ACTOR W 1827 RC AND 296^00'N�AC. <br /> � ���� �� <br /> / * ^ <br /> Signa ure w7� u omraclonAut or ed Agem Date <br /> ' DEBIT & CRE6T CARDS ARE NOT ACCEPTED <br />