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�- PErtMIT APPUCATION � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 (7 <br /> � �b��- aod j <br /> SITE ADDRESS PAR:EL TAX I.D.# PERMIT z I <br /> l2/y Co/h �ve. 0 228o2200D �� �jc�7 - �� ' <br /> LEGAL LOnTNO. BLOCAK TRACT I / <br /> DESC. 2�G cJ- � �2!S � � I�G Yl �-G�. O Y" S �. �3� <br /> OWNER A�ORE55 ZIP PHONE <br /> �o��r a--le�rr,-��� layyer I2f� Col6�/�,.P 98zo1 y2s-33y-zs3z <br /> TENAN �AME CONTACT FOR PERMIT PHONE <br /> Saw,e q 5 owH�r" owner owner <br /> CONTRACTOR AODRESS �/ 21P CONTR.LICENSE# ' <br /> fust �i�17`QN•%�ih�Se�r�s 2oy N Co�rpe.�T��4� c�i90 TNSTiQ8f�9�3JS <br /> rHo�z S- 330 -yy y2 Sneha.�y:S�t, �?/� <br /> PROPOSED 11SE OF BUILUING � rIrI��vvd�dV Uildi�g D Mechanical �L�,/Addition HEAT SOURCE <br /> I PERMIT �ombinalion U Plumbing IWORK I ) Alteretion I � Electnc <br /> �-aY-0.q e TYPE Demolition U Sipn TYPE H New Gas <br /> -J Sprinkler � IJ Repair/MainL Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> WORK DESCRIPTION Q��O � � 6N o ^ '/ � 1 <br /> 17�"� f�ZGiS �✓� c�,rrcc, E . 1�C"��or�cipinc �ti �7"5 P��iF-� <br /> CZ�`.K ZG �) � � `' a�tiew���4G� <br /> z'i x 36 � <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A!C-A/HANDLING UNITS I <br /> BATHTUB FORCCD AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY'iRAY WATER HEATER I <br /> CLOTHES WASHER METAL FIREPLACE/STOVE , <br /> = URINAL FIREPLACE INSERT i <br /> DRItJKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICErBAR/�10PrETC.) EXHAUST FAN I <br /> _ OTHER _ OTHER i <br /> — I <br /> � <br /> II NEREBY CERITIFY THAT I HAVE REAO AND E%r�MWED TNIS APPLICATION AND KNOW THE SAtrIE TO BE TRUE ANU CORRECT. ALL � <br /> i PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK lh9LL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR � <br /> NOT. THE GRANTING OF A PERtJ1T DOES NOT PRESU6IE TO GIVE AUTHORItt TO VIGLATE OR CANCEI THE PROVISION OF ANY OTHER � <br /> STATE OR LOCAI LAW REGULATING CUNSTRUCTION OR THE PERFCRtdA�VCE OF CONSTRUCTION. THAT!AM AUTHORIZED BY THE I <br /> OWNER OF THIS PROPERN TO PERFORAI THE 4'VORK FOR\YHICH APPLICATION�� MhDE AND I COMPLY WITH THE STATE � <br /> CONTRACTORS LAW�827 RCN.�ND�96.200 tYAC. ' <br /> ��a fl���,._.,.�_� S�(Q�O�/ <br /> Signa re o wner/ ontr ctor/Authonzetl Ageni Da�— �a I <br /> i DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED � <br />