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------- -- - � <br /> PERMIT APPLICATION ' <br /> CITY OF EVERETT PERMIT SERVICES ! <br /> 3200 CEDAR STREET, EVERETT, WA 98201 i <br /> 425-257-8810 - FAX 425-257-8857 i <br /> SITE ADDRESS PARCEL TA%I.D.iF PERMir a <br /> 2.y2 � c����� sr tio7 z ov�'�-v3�v ' -Q22 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> S �P,�ry �['��S 2y1 7 « <Iq. S/- 7 �,�-� I <br /> TENANT NAME j CONTACT FOR PERMIT PHONE <br /> Tir�/ ;'^���1'•/ \���'S�.Z�'� -`ICr.�'� <br /> L— <br /> CONiRACTOR AODRESS 21P CONTR.UCENSE N <br /> rN� l�d,ifra� 1'a' `-, i ��< . /�.'_'! //5 T�57 N[' L�,n,�a ����f (I� �II��--_ <br /> PHONE � TM�D.�y���E�S <br /> �f)5 25�� .. yc�� <br /> PROPOSED USE OF 9WLDING I� Bailding I"") Mechanical IpS Addition HEAT SOURCE <br /> PERMIT �6� Combination �_� Plumbing WORK �� Alleration Electric <br /> TYPE �( Demolilion LJ Sign 7YPE � l New Gas <br /> U Sprinkler I U Repair�MainL Other <br /> CONTRACT PRICE OF WORK �• ��� �` �, CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I�J (/ <br /> WORK DESCRIPTION <br /> � -f -1;�7.� ��v �SZG s-� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM � <br /> I, <br /> I WATER CLOSET (TOILET) ___ A/C--A/HANDLING UNITS i <br /> �_ BATHTUB _ FORCED AIR SYSTEMS <br /> �_ LAVATORY (WASH BASIN) _ HEAT PUMP <br /> _j_ SHOWER UNITHEATERS <br /> KITCHEN SINK 8 DISPOS�L _� CLOTHES URYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> I = CLOTHES WASHER _ METAL FIREPLACElSTOVE <br /> � URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> � BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICEiBAR/MOPIETC.) �. EXHAUST PAN � <br /> OTHER _ OTHER ii <br /> _� �i <br /> i ���REBY CERITIFV THAT I HAVE READ AND E!WMINED THIS APPLICATION ANO KNOW THE SAME�i0 BE TRUE AND CORRECT. ALL ' <br /> ���+OVISIONS OF IAWS AN�ORIDINACES GOVERNING TNIS TVPE OF IVORK WILL BE COPdPUED WITM WHETRER SPECIFIED HEREIN OR . <br /> •�G' THE GRANTING OF A PERMIT DOES NOT PRESUAfE TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER '�, <br /> �;TA?E OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE � <br /> J,�NER Of THIS P@OPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE �. <br /> CONTRACTORS LAW ib27 RC'N AND 296..OG WAC. � <br /> I <br /> i �.w� -1��� � lt- �s o v <br /> SiqnaWre�Owner ontraclovAulhonzed Agent Date <br /> D E B I T & C R E D I T C A R D S A R E N O T A C C E P T E D <br /> ��Z <br /> II <br />