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P�RMIT APPLICATI�N <br /> C17Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N PER T <br /> Za�) �. C,�,�,;,,� �vc�. c�o5987 -oo0 - vo� -�� � ���` �� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> ;��,,,,, 5� L�.s�- �t��s- �o,��,as Ave N. �203 9sio� i�)Zbo-3313 <br /> tENANT NAME I CONTACT FOR PERMIT PHONE <br /> l�Td l (,��re�e55 Sz�d:�e5 L la,�ts. L�ro�e� <br /> CONTRACTOR r— 1 ` ADDRE39 21P CONTR.LICENSE M <br /> �O 4j(� �efi111./1� /1 <br /> PHONE �/�.i � ��, l_�Q,,^ c ''� <br /> ll .: <br /> P OPOSED USE OF BUILDING BUilding I� MechaniCal �} Addilion HEAT SOURCE <br /> (,��fe��5� (�q+iUI�G',1��^ PERMI7 R CombineUon H Plumbhig WORK f� NleraUon D Electric <br /> TYPE g Demolillon V Sign TYPF. g New U G89 <br /> '���� � {'y Sprinkler RepalrlMalnt. U Other <br /> CONTRACT PRICE OF WOR�S� �v CITV OF EVERETT LOCAL SALES TAX COUE IS 9105 <br /> WORKOESCRIPTION �0�1'.-lJ,�,t..li�11 O'� uv1(5'16Cr '(.�'CC.J/lilqll(1,1-.11 "{. '.N� LlL' ' ' j i�1�i�G. �\1 <br /> l�. ��C�'11�1.�5 01�1 d- fDu�+O� G��QL p�K�tJIIIViti+ CUNJ�IV'�$ �CJII�iJ�q �(�tk.0 O�vl(� <br /> � �1 <br /> el��v�'1;(. �U.�Qni�e.t�� on -�vt U !'vl.�n <br /> V <br /> pLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> WATER CLOSET(TOIIET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASFiER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN ^ GAS RANGE <br /> BACkFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/1.10P/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY TI1AT I HAVE READ AND E%AMINED THIS AFPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTV TO FERFORM THE WORK FOR WHICH APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br /> CONTRACTORS W 18 27 RCW AND 296.200 WAC. <br /> Sig�.v� �.�---�� U/ � Z�G J � <br /> naWr�er/ ontracror/AulhonzedAgent ate )Z <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />