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. - ,- <br /> � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320D CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX�.D.N PERMIT t <br /> Zq i� c� �oY Av� �0 44 -88:3-c��$-ao Mo �a-oa� <br /> LEGA LOTNO. BLOCK TRACT <br /> UESC. <br /> OWNER ADDRES9 <br /> ZIP PHONE <br /> Bra�ey JAR���i Z� 55z-(o3io <br /> TENAN7 NAME� CONTAC7 FOR PERMI7 PHONE <br /> �b����u�is - �,02�; Sr�K; I l���ir11'�fA i rl�wS Z 5 3 �0 4 0 737 <br /> CONiRqCiOR ADDRESS 21P CONTR.LICEN9E1 <br /> PHONE <br /> PROPOSED USE OF BUILDING Buildi�g Mechani <br /> AdCitlan I NEATSOURCE <br /> JL'�l :j�!''�'O�LiCl� PERMIT Combination Plum mg WORK B qiteration � Eleclnc <br /> ���� TYPE Demolition Sign TYPE New Gas <br /> Sprinkler B RupainMaint. Other <br /> CONTRACi PRICE OF WORK �j <br /> �s(�'J� (k7 CITY OF EVERETT LOCAL SALF9 YAX CODE IS J106 <br /> WORK DESCRIPTION <br /> T��r.Hr Ir�PaavEr�cki� UPCTBAnt_ �Xis7'�.v�; af,e-r.� t-'a,e S�a�NA.o��� <br /> ��r� �����e�—� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FI%TURE OR ITEM <br /> _, WATER CLOSET A/C-A/HANDLING UNITS <br /> _ BATHiUB _ FORCEDAIRSYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SIIOWER __ UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL _ CLOTNES ORYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY � WATER HEATER <br /> _ CIOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPIACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER � GAS PIPING <br /> _ SINK(SERVICElBAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER OTHER <br /> — � . T.i�+r li f/a , Fil✓ � <br /> i — <br /> I HEREBY CERITIFY THAT I HAVE READ A�p EXAMIN�D THIS APFLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS qND ORIDINACES GO�'ERNING THIS TYPE OF WORK 1MLL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> N07. TIiE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR IOCAL LAW REGULATING CONSTRVCTION OR i HE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED RY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WURK FOR WHICH APPLICATION IS MADE AND I COMPLY 1M7H THE STATE <br /> CONTRACTORS LAW 18,27 RCW AND 296200 WAC. <br /> Signature of Owner/ConlractarlAuthor+zed Agent Date <br /> IDEBIT& CREDIT CARDS ARE NOT ACCEPTED \I� <br />