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-v1�1�0 <br /> ���RMIT APPLICATIOi� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 :.EDAR STREET, EVERETT, WA 98201 <br /> � i� 425-257-8810 - FAX 425-257-8857 <br /> � i <br /> — ; <br /> SITE ADQRESS PARCEL TAX I.D.# PERMi7« � <br /> Z � Go��v A�. o0 4 3a i�z4o27 00 , � _ q i <br /> LEGA LOTNO. BLOCK TRACT I <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE - � <br /> I <br /> ��rc��rr svMPibNY �so'i wh�� s-r. 9a2o� c9zs� zs�-4,3�2 I <br /> 'fENANT NAME CONTACT FOR PERMIT PHONE i <br /> �JEIZLTT SYMGNONY P�NbY ��hLL. C4zs) 25`1-O`�'`3 I <br /> CONTRACTOR ADDRE55 ZIP CONTR.LICENSE# II <br /> �AFI`NEX l.oNsT��lohJ 10511 19� /�vF. S�� y3Pp� ���N�SIo�k3 <br /> PHONE q25 -338'ZI14 SJ�TE L <br /> PROPOSED USE OF BUILDING Building I� Mechanical I ��ddition HEAT SOURCE <br />, �AI� OU-vpAULY I PERMIT Combinalion �_� Plumbing WORK [JJ Alteration � Electric <br /> IZENh1Zsh'^IoFK�L�s TMPE Demolition LJ Sign TYPE D New Gas I <br /> Sprinkler U RepairRdaint Other i <br /> CONTRACT PRICE OF WORK ����Z op CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> I <br /> WORKDE3CRIPTION T�i�f/�NT IMPIEAV6M�NT 0� (o�G00 �. SI�P,a�. I <br /> I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A�C-P/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) NEAT PUMP <br /> SHOW[R UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTViES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNGRY TRAY WATER HEATER <br /> CLOTHES WASHER P�AET.AL FIREPLACE/STOVE <br /> URINAL FIREPLACE I��SERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTFR GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER I <br /> — — I <br /> — � <br /> I HEREBV CERITIFY THAT I HAVE REAU AND EXAIvIINED THIS APPLICATION AND KNOl4'THE SdME TO BE TRUE AhD CORFECT. AlL � <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK 6VILL BE COh1PLIEJ N9TH WHETHER SPEGFIED HEREIN OR �, <br /> N07. THE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL TNE PROVISION OF ANY OTHER '� <br /> STATE OR LOCAI LAW REGUfATING CONSTRUCTI01:OR TN�PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE ; <br /> OWNER OF THIS PROPERTY TO PEFFORM THE WORK FOR IVHICH APPUCATION IS�dA�E AND I COh9PlY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND:96.:.00l4'AC. <br /> I <br /> ���,,,:_ �ra,l�� //�z/��' � <br /> Signature of Owner/Contrector/Au on tl A�ent Dat 1/�� <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED _% i <br />