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, <br /> � PERMIT APPLICAt� ION <br /> CITY OF EVERETT PERMiT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810— FAX 425-257-8857 �� ,�, `S <br /> 't� <br /> lD3 PARCEL TAX I.D.N Nenr.SiT ii <br /> SITE ADDRE � ,�-0tlo <br /> �j� � 00�1000 -oo0-v334o3 � <br /> LE�A LOT N0. BLOCK TRA�T � O��1'L <br /> DESC. � V <br /> OWNER ADDRESS �P °MON3qj_736o <br /> Iioo.cK l�ros. Cntis�- 3�aa a���.uE. �� a�.os `125� <br /> TENANTNAME <br /> CONTACT FOR PERMIT PMONE <br /> ���.��; �3�. c�s�f-, �e� 1-k�.�.ck H25-2�o-2qZY <br /> CONTRA O A RESS ZIP CONTR.L�CENSE N <br /> ���,�� `�ns, Coc�s+� 39�a ��i�r�P-��- �14��5 Ho,ack►��s.o�ipz <br /> PHONE c_3�, '�3 6� <br /> J Additbn HEATSOURCE <br /> PROPOSEO USE OF BUILDINO I � Buliding MeChanical <br /> PERMIT Combination Plumbing WORK Alteratlon � Qectric <br /> N ��) Sr�� I TYPE Demolition Sign �PE qepalr/Melnt. Other <br /> Sprinkler <br /> CpMTppCT PRICE OF WORK �S �Q�� CITY OF EVERETT LOCAL SALES TAl(CODE IS 3f05 <br /> WORK DESCRIPTION � �� S Fl1 '- ��� <br /> ,B�il�� c, 2 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM N0. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB � FORCED APR SYSTEMS <br /> � LAVATOFY (WASH BASIN) _ HEAT PUM <br /> SHOWER UNIT HEATERS <br /> = KITCHEN SINK&DISPOSAL �. CLOTHES DRYER <br /> � DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> � CLOTHES WASHER _, METAL FIREPLACE/STOV[ <br /> URINAL FIREPLACE INSERT <br /> ORINhING FOUNTAIN � GAS FIREPLACE <br /> �I FLOOR DRAIN GAS RANGE <br /> B4�KrLOW PREVENTER GAS PIPING <br /> � SINM:(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER _ OTHER <br /> � — — — <br /> I HEREBY CERITIFV THAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> ' PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR <br /> �� STOATE OR LOCAL ILAW REGULATING CONS RUCTION OR THE PERFORMANCE OF CO STRUCT ON. THAT AM AOUTHORI ED BY HE ER <br /> OWNER OF THI:,PROPEflTY TO PERFORM THE WORK FUR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> C TRAC S LAW 1827 RCW AN�296200 WAC. <br /> � -�. I/L I <br /> � Si naWr ot Ow r/ on r Or uthorRe ent Dale <br /> DEBIT & c.9EDIT CARDS ARE NOT ACCEPTED <br />