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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> I 425-257-8810- FAX 425-257-8857 <br /> I SITE ADDRESS PARCEL TAl(I.D.A PER IT p <br /> 0 I CU►��►� � S G oc�o o S-oo / <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. CjU(� �O�Zl1�. �Qpl 1�Qn� <br /> OWNER ADDRESS ZIP PHONE <br /> /-+M�{ LUTKE2 lf4ME h'S �UV�, y� 2S°f - 164(� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> � I �i�►c. l�q,.r,orJ I�ZS-330- g73y <br /> CONTRACTOR l��;J �UM�S ,y�C„ ADDRESS 21P CONTR.UCENSE N <br /> fl•J 3nx 1�4L �qq/5D//20//8� <br /> PHONE �loN�o� WA �GaL7Z <br /> Z�-330 - �3 <br /> PROPOSED USE OF BUILDING (�Building I") Mechanlcal Addltion HEAT SOURCE <br /> I PERMIT {� Cambination � � Plumbing WORK R Alleratlon � EtecUlc <br /> ���p0(� TYPE D Demalilion U Sign TYPE k� NeW ce5 <br /> �� Sprinkler �oi Repalr/Malnt. Olher <br /> CONTRACT PRICE OF WORKIC �SGO UV CITV OF EVERETT LOCAL SALES TA7f CODE IS J705 <br /> `#' <br /> WORK DESCRIPTION p � _r,��� _� /�QD�T GLJO�= c 1, �f � <br /> f-r... �nv" l 4k F�KWI— <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TVPE OF FI%NRE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITu <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> I = SHOWER = UNIT HEATERS <br /> KiTCHEN SINK& DISPOSAL CLOTHES DRVER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WA =R 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/8ARlMOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I — — <br /> I — <br /> ! i HEREBV CERITIFV THAT 1 HAVE READ AND EXAMINED 7HIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> �� PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> �' NOT THE GRANTUJG OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br /> , STATE OR LOCAL LA'N REGULATING CONSTRUC710N OR THE PERFORMANCE OF CONSTRUC710N. THAT I AM AUTHORIZE�BY THE <br /> IOWNER OF THIS PROPERTV?O PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTO W iB.27 RC' AND 296200 WAC. <br /> � ��--'G�3P S Z-z-�y <br /> ! Signalure o Owner/ ontractor/Authonzed Agont Date ��/�, <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED �� <br /> r <br />