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I <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610-FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAl(I.D.N PERM�T t <br /> "�7z '�l g0'{01-00 <br /> LEGA LOT N0. dLOCK TMCi <br /> DESC. <br /> OWNER ADDRESS LP PHOHE <br /> y�s- Zsz- i.yc� <br /> I A1J�'r= C"i�/L l3zz L°iz,�3�/ �t $ Zul -- - <br /> TENANTNAME CONTACTf RPERMIT PHONE <br /> `�3���e Ccw� I Gt�iG�r�da/ yis- �s7� �-Gz�s <br /> CUNTRACTOR C/2 C��S-�LC"j](,AI ADDRESS � ��p � C�/�,V�[,ti� ZIP CONTR LICENSE K <br /> `' �,�<�a��� � ti'4z'ts" 5r1�����lb oT <br /> PHONE �JZ� 3��-0�;/C/ <br /> � 7a <br /> PROPOSED USE OF BUILDING �.Building � Idechanical I AOAition I HEAT SOURCE <br /> I PERMIT i{�--( C_ombination Pl�rtlbi�g WORK Al�eraiion D ElecUlc <br /> TYPE �,j Demolition Sign TYPE�New U Gas <br /> lJ Sprinkler RepaidMaint. U Other <br /> CONiRACT PRICE OF WORK��r{�v CITY OF EVERETT LOCAL SALES TAX CODE IS J706 <br /> i <br /> WORK DESCRIPTION ,�/ �/ ,f n�—� <br /> ��'L 3 v'7�S G/ ��/VY� � I�i.I"7�-� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET AIC—AIHANDLING 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 HOOD <br /> IAUNDRY 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 /> S�NK(SERVICEIBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AN�KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED 1MTH�M!ETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES N0T PR[SUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STAiE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BY THE <br /> OWNER OF T/iIS ERTY TO PERFORM THE WORK FOR WFiICH APPLICATION IS MADC AND I COMPLY WITH THE STATE <br /> CONTRACT 18. RCW AND 296200 WAC. <br /> � � � Z-v� <br /> ure of Owner/Contra uthorized Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />