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PERMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADORESS PARCEL TAIt I.D.N P MiT a <br /> ::Z I l 3 CP�ar Sfri�f I �(03 r o - o� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS 21P PHONE <br /> Lo��s e SrLq.n 2 �/3 4�a� s �ir�t 9s'zo/ yzs-zs8'-8'ozl <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> L DU/S C' L 1!l:4.q I LOU/S C To/en y 2 ,�'1�y���Z � <br /> CONTRACTOR No,+l! Uw�!/ ADDRE93 � 21P CONTR.LICEN9E M <br /> PHONE <br /> PROPOSED USE OF BUILDING Buitding bti Mechanica) HEAT SOURCE <br /> S�/� PERMIT Combination F_� Plumbing WORK � Altaratlon � Eledric <br /> it TYPE DemoHtion �� Sign TYPE New Gaa <br /> Sprinklnr RepalriMalnt. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL 8ALE8 TAX COUE 18]105 <br /> WORKDESCRIPTION =^S �y�/ m41� �al ���( u� rfv/� ��.ilS �e� �v/qaCP � Wy�!/' h/+ N An J��✓/ <br /> �nr� �iyr�. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF F�XTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> _ B.ATHTUB � FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL � CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY � WATER HEATER <br /> _ CLOTHES WASHER 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/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFI'THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br /> PROVISIONS OF LAWS ANO ORIDINACES GOVFRNING THIS TVPE OF WORK WILL BE COMPLIED WITIi WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTIiORIZED BV THE <br /> OWNER OF THIS OPERTV TO PERFORM TFIE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS W 18.27 RCW AND 296.200 WAC. <br /> bPC /o U <br /> Signature r/ ontrectodAuthonzed gent ale <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />