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. l <br /> PERMIT APPLICATI�IN <br /> CITY 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.p PERMi7 a <br /> Z OCo i� ' T 1'v�v3ll-o0 <br /> LEGAL LOTNO. BLOCK TRACi <br /> DESC. <br /> OWNER rj�� �/Y ADDRESS 21P �6 JE-�St3-�fS2LS <br /> O/C <br /> o a 6/7�r �-�•v �9�'7 /01 �L, .�I� � �s'�/s✓�L��- u1,Os h <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> {��RKu,� .�'�� �7' L5(S—�15�� <br /> CONTRACTOR ADDRE53 21P CONTR.LICENSF/ i <br /> PHONE I� <br /> PROPOSED U:1E OF BUILDING �-guIlding MeChanlcal dltlon HEAT SOURCE ��. <br /> PERMIT KI--( C_ombinalion RI--( Plumbing WORK Alteratlon fIi'� �Elednc <br /> ��:./�/T?�c_ TYpE �j �emolilion U Slgn TYPE New � uea �. <br /> U Sprinkler Repalr/Meint. Olher <br /> CUNTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAI(CODE IS 7tOb <br /> WORKDESCRIPTION V�J PA� � //V ���� � P�Q(y T9 �u[�j�n <br /> ��/� -u�J �X I 5 i N!. <br /> T� N�S /�l'JL4'7-l�= 6J .t�ik"T "� IC1U. 5/1X� UtG �'�'u� 1 � <br /> PLUMBING MECHANICAL <br /> NO. IYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER i.LOSET(TOILET) _ A/C-A/HANOLING 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 FtOOD <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 /> V,��,�� — <br /> i HEREBV CERITIFY THAT I HAVE REAO AND E%AMINED THIS APaUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PFOVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL PE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A FERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL TME PROViSION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION JR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AN01 COMPLY WITH THE STATE <br /> CONTRA TORS LAW 18.27 RCW AND 296.200 WAC. <br /> �� `��.. �,�fY�✓o 3 <br /> e/I��r <br /> Siynature of 0— wne�,rl orntracror/Authanzed Agenl Date <br /> � DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />