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� <br /> P�RMIT APPLICATIa�IV i <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 i <br /> SITE ADDRESS ?/+kCEL TAX I.D.# PERMIT# <br /> ��?(y CcL �3 �fV�' JCU G� 0 ' <br /> LEGAI LOTNO. ELOCK TRACT <br /> DESC. <br /> OWNER ADORES� ZIP PHONE il f',p'� <br /> v�/ <br /> f���LL G-OSPFL M�SSiON �HURC� 2yly fo�gy � v� � vevc��/ Wr( <br /> TENANTNAME CONTACTFOR PERMIT PHONE <br /> CONTRACTOR g(j %N��RtNp/`J,�,AG ADDRE55 ZIP CONTR.LICENSEp <br /> /�/3J.�: "`,Y72JA .i�49 /6�f�� W d <br /> PHONE SP/!7 T«' W/� �I�J <br /> .2v�-37Z-d n 9� <br /> PROP03ED USE OF BUILDING fl f3uilding Mechanical Addiuon HEAT SOURC[ <br /> �,J ���rX���t PERMIT �� Cumbination R�4�Plumbing WORK Aneration Q Eiectric <br /> / 7YpE �_1 Demolilion U Sign 7YFe New �j Gas <br /> ` �,,,��y U Spfinklef RepairfMainl. L) Other <br /> CONTRACT PRICE OF WORK � �p�) CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORK f1E5CRIPTiON �zo;,��,�. �� u k9 f�� ��.•. � ��<.a'� �t//-Ct-u�7i,Ci�� <br /> �/ <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OF FI%TURE OR ITEM NO. TYPE OF FI:(TURE OR ITEM <br /> � WATER CLOSET(TOILET) _ A/C—FVHANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> � IAVATORY(WASH BASIN) _ HEAT PUMF <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK&DISPOSAL C�OTHES DRYER <br /> DISHWASHER RANGE fi00D <br /> LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER MGTAL FIREPLACE/STOVE <br /> � URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> � FLOOR DRA�N _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETCJ _ EXHAUST FAN <br /> OTHER _ OTHER _ <br /> � <br /> i I HEREBY CERITIFY THAT I HAVE READ AND EXAMINEC THIS APPLICATION ANU KNOW THE SAME TO BE TRUE AND CORRECT. ALL �i <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF N'OkK VJILL BE COA4FLIED WITH WHETHER SPECIFIEO HEREIN OR � <br /> i NqT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER I <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 6Y THE <br /> iOWNER OF THIS PROPERTY TO PERFORAd THE WORK POR WHICH APPLICATION IS IdADE AND I COMPLY WITH THE STATE I <br /> CON7RACTORS LAW 18.27 RCW AND 296200 WAC. I <br /> � .LCc�.,> ,�, �^�, O� �'t''� <br /> , Signature of OwnerlConlracro/Authonzed Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED , <br />