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P�2MIT APPLICATIO�J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3�00 CEDAR STREET, EVERETT, WA 98201 �d �1 6-O� <br /> 425-257-8810 - FAX 425-257-8857 � <br /> �v� yo7 ' �O� <br /> SITE ADDRESS PARCEL TAX I.D.# PERhti7 tt <br /> f / 907-D' <br /> .3�5 ! �' �`'f•rl � ��7�, y�SYlO � 8 o'�--c�o _ c�o <br /> LEGAL LOT N0. BLOCK T�CT '/ /J`, � � � <br /> DESC. - U ��) �L 77 lU` l�C� C7 � <br /> OWNER ADDRESS ZIP PMONE <br /> �. � C rydZZ3 3Gu-43S-S11'� <br /> fC1��lc 'c. �p�,�U�v� �_�"� ZL�'rc� l,nk� ��� �ey I�oac. <br /> TENANT NAME CONTACT FOR PERMIT r �75 n pHONE <br /> ��v��C i'-� �'�ric � J60- (�SI- Illd' � <br /> CONTRAC R (� <br /> ADDRESS ZIP CONTR.LICENSE q <br /> � W�t' h ��v� cL <br /> PHONE <br /> PROPOSED USE OF BUILDING � Building D Mechanical [[[��� Atltlilion HEAT SOURCE <br /> PERMIT Combinalion U Plumhing WORK � Alteranon � Elecuic <br /> ��1�12 L h�U'�r- TMPE Demolition U Sign TYPE New Gas <br /> Spfinkler RepairlMainL Olher <br /> CONTRACT PRICE OF WORK�S' ��jJ �`�' CITV OF EVERETT IOCAL SALES TAX CODE IS 7105 I <br /> WORK DESCRIPTION <br /> •�� C-F C:: �t�ZQIW..+�. r�r W�f � r•.cr �r_ p�'�F1i'��. <br /> NCw' ZOC,r - 1 <br /> I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C-A/HANDLING UNITS � <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BNSIN� _ HEAT PUMP <br /> � SHOWER _ UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHEF RANGE HOOD � <br /> — WATER HEATER � <br /> LAUNDRYTRAY — <br /> �� CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> ��. URINAL _ FIREPLACEINSERT <br /> '� DRINKING FOUNTAIN GAS FIREPLACE I <br /> I FLOOR DRAIN _ GAS RANGE <br /> I BACKFLOW PREVENTER _ GAS PIPING <br /> I SINK (SERVICE/BARI"dOP/ETC.) _ EXHAUST FAN <br /> , OTHER _ OTHER I <br /> I — i <br /> �� HERE�V CERITIFV TH!!T I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � r S AND ORIDINACES GOVERNING THIS TYPE OF\VORK WILL BE COh1PLIED WITH WHETHER SPECIFIED HEREIN OR li <br /> .'�OVISIONS OF LAW <br /> !dp,'. TME GRANTING OF A PERMIT�OES NOT PRESUh1E TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION Of ANV OTHER , <br /> STATE OR LOCAL LAW REGULATING CONS i RUCTION OR THE PERFORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE I <br /> OLNNER OF THIS PROPERTV TO PERFOR61 THE WORK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONTRACT }8.�7 RCW AND 296200 VVAC. �I <br /> �-- l,>. ��� ,I� I <br /> '/ " /,, Cr"�+� C-- <br /> Si9 tur�of OwneriContractor/Authonze0 Agent Date I <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />