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� P�RMIT APPLICATI�iN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-R810— FAX 425-257-8857 <br /> SITE ADDRESS t�„P;� PARCEL TAX I.D.N PERMiT p <br /> ��S W� CL'1.�� IZir.c�l � I - (�o�.£3s� ( Q o3oG-oq <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADD RESS ZIP PMIONE <br /> :�-•�n�,��J '�,t�;I �s�`�.�u,uuxs �ols 3�'Avc..# �o►o � So�r',}�.,�uH. qg�r� ablo-5 h'-ob�l� <br /> TENANT NAME CONTACT FOR PERMR PHONE <br /> Sou�ol�i✓ K�le L,'�rx�s ��11� -�.�- <br /> CONTRACTOR � ADDRESS n�����,, �� �� ZIP CONTR.LICENSE N <br /> EQSg U G��fl �ry uYe�!\ ��� 1 rmw�✓ ' <br /> PHONE ��J .X�"� 1 � ' '7g�p� t1`1fs/Kt' �o/33'K <br /> 2Ub-- -3�-�' — <br /> PROPOSE�USE OF BUILDiN6 � Bullding MechanlCal Addltlon HEAT SOl1RCE <br /> PERMIT Combinalion R{-( Plumbing WORK Alleretion R Elactrlc <br /> �v��/�1,CS, TYPE Demolition U Sign �E RepalrlMeint. v Other <br /> d Sprinkler <br /> CONTRACT PRICE OF WORK ��-flO� ,�Q CITY OF EVERETT LOCAL SALES TAl(COOE IS 7105 <br /> WORK DESCRIPTION �n 1 _�1 ,�„1 ����.�.�r ry���- VC��G • '�`/� )✓GV�a V �JO/ <br /> .SIG i� i.-r�.r �–�- u <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATERCLOSET(TOILET) _ A/C–A/HA�-�LINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEA�PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 6 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CI.OTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR ORA�N _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> � — <br /> i <br /> I I HEREBY CERITIFY THAT I HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRE . <br /> �ROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OP WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �IOT. THE GRANTING OF A PERMIT�OES NOT PR[�UME TO GIVE.4UTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER I <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE I <br /> OWNER OF THIS PROPERTY TO PERFO THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAW 18.27 R W AND 2 200 WAC. <br /> �� _ , ;/� (j'L�'Q� � <br /> Sidnature of Own /Co ct ulhc ed Agenl e�e �/Z <br /> EBIT& CREDIT CARDS ARE N07 ACCEPTED <br /> �__ - <br />