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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 � <br /> SITE ADDRESS � PARCEL TAX I.D.# PERMIT <br /> Z �Z � � � A � oar�yu �3 Oo a� /� ��-bU1� <br /> LEGA LOT'NO. BLOCK 1RACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> / � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> .A� a����� eo ���s'. J UA�J �I�rtrt�c�C,�. Zo� s�-� og �¢ <br /> CONTRACTOR � AD�RESS �.}. ZIP CONTR.LICENSE M <br /> LI B�TY ��a�l(�J ID�os� -� 20l ���t ��031 LI��� -H:Op� <br /> PHONE •z DYJ �� D��¢ <br /> PROPOSED USE OF BUILDING Building Mechanical I] Addition � HEAT SOUR�E <br /> I PERMIT B Combination P�umbing IWORK � ) Alteration I � Electric <br /> TYPE D Demolilion Sign TYPE � New Gas <br /> U Sptinkle� Repair/Maint. Other <br /> CONTRACT PRICE OF WURK I D SOD CITY Or EVERETT LOCAL SALES TAX CODE IS�705 <br /> WORK�ESCRIPTION <br /> -�;q� t�i I�C-r �LOD21,(�F'. �AJ�ID �x I�UST If'DOD GLASh I <br /> W 1�-t�• �i4k) A N 9 H n � U p Al dl N a 1� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR I7EM <br /> WATER CLOSET(TOILE� A/C—A/H��NDLING UNITS <br /> BATHTUB FORCFD AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HE.4TERS <br /> KITCHEN SIP1K 8 DiSPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACElSTOVE <br /> URINAL F�REPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER Oi'HER <br /> I <br /> II HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br /> PROVISIONS OF U�WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMI i DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION Of ANY OTHER <br /> STATE OR LOCAL LAY✓REGUI.ATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUC710N. THAT I AM AUTHORIZED BY THE <br /> OWNE�OP THIS PROPERTY TO PERFORI:7 THE WORK FOR WHICH A PLICATION IS MA E AND I COMPLY WITH TI1E STATE <br /> CONTRACTORS 182T CW AND 296.�00 WAC. � ����� / <br /> t <br /> Signatureo Ow lContra�Tar/Autfiorized Agent �ate <br /> �, > DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED /L <br />