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,. _ P"'RMIT APPLICATI N <br /> � CITY OF EVERETT PERMIT SERVICES ��y,�y <br /> . "�' 3200 CEDAR STREE7, EVERETT, WA 98201, 425-257-8810 <br /> _ � �;i�>;x <br /> SITE ADDRESS PARCEL TAX I.D.# PERMITtI <br /> 'I I ��-�PI<I I�I . I A'I Itfl-I�. AI'n <�x�u; unrC35ounu�liiu �'; ' , _ � . _�) _ ; <br /> LEGAL — LOT NO. BLOCK ITRACT <br /> DE$ — _-- — — <br /> OWNER ADDRESS PHONE <br /> 'I I t�,V'It1 PI. <br /> GI ,A�ti. ( Illtiti ,A P�V'I.r� 1-C>1"�II-7i��1 <br /> � F.\'1�1217 I. \1�A '�R'll; __ <br /> TENANT NAME CONTACT NAME PHONE <br /> i�:��nininii i,� si �-;i�i .i;; <br /> CONTRACTOR ADDRESS CONTR.LICENSE# <br /> I \til K;\ IIItIIf.AII�KI't�\1P:\11' I.'idil I ;.'\'1� :11'I 11 f:\SI\1ll��u;.'.I�I� <br /> Flltl:l.:�\I). 1t�:1 '�Xu;J u.' Ib 'nn� <br /> PHONE � r�i�ii�'i,i <br /> PROPOSED USE OF BUILDING Bulldi�p �Machanica WORK Additlon HEAT SOURCE <br /> PERMIT . Comhlnetlon Plumhl�g � Al1er�Uon []Eleclnc <br /> TyPE Domolilfon Slgn TYPE New ac <br /> � � Re elrlMalnl fher <br /> CONTRACT PRICE OF WORK c;.i�>nu CITY OF EVERETT LOCAL SALES TAX CODEIS 7105 <br /> WORK DESCRIPTION �t ,i�i�„� �tr�,�iir I Ircirk \1,urr Ilratci <br /> UMBI MECHANICAL <br /> NO TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTl1RE OR ITEM <br /> WATER CLOSET _______ A/C-AINANDLING UNITS <br /> BATHTUB _______ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _______ HFAT PUMP <br /> SHOWER ______ UNII' HEATERS <br /> KITCHEN SINK 8 DISPOSAL _______ CLOTHES DRYER <br /> DISHWASHER ____ __ RANGE HOOD <br /> LAUNDRY TRAY _____�.__. WATER HEATER <br /> CLOTHES WASHER _____ METAL FIREPLACEISTOVE <br /> ----' fIREPLACE INSERT <br /> URINAL ------ <br /> ORINKING FOUNTAIN __�_ GAS FIREPLACE <br /> FLOOR DRAIN ,___ GAS RANGE <br /> BACKFLOW .^REVENTER __�_ GAS PIPING <br /> SINK (SERVICEIBARIMOPIETC.) _�__ EXHAUST FAN <br /> ----- ------ OTHER------------ - --- <br /> ----- ------- <br /> - --- <br /> t NERFBY CCRTIFV �HAT I MAVF. R[AD AND E%AMINED THIS APLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT.ALl <br /> PROVISIONS OF LAWS A4U ORDINANCES GOV[RNWG THIS TVPE Of WORK WILL BE COMPUED W�HT WHETNER SPEGFIED HGREI <br /> OR NOi THE GRl�NTING OF A P[RMIT DOES NOi PRESWdE TO GNE AUTNORITV TO VIOLATE OR GANCEL TIiE PROVISION OF ANY <br /> OTHER STATE OR IOC�L LAW REGUTATING CONSTRUCiION OR TME PERFORMANCE OF CONSTRUCTION.TMAT�AM AUTHORIIE� <br /> BY 1 HE OWN[R OF TNIS PROP6RTY TO PERFORM TME WORK FOR WMICH APPLICATION IS MAOE AND I COM7LY WITH TNE STATE <br /> CONTRACTORS l !�W iB.27 HCW A4D 29fi 20�WAC. <br /> SlgnaWrc of OwnedConlractorlAuthorizod Agen Date ��� �, ,����5 <br /> � ui�zi <br />