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l ; <br /> PERMIT APPLICA'TION <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 N <br /> z �t z 3 <� l:s �}- � ko�o2 -oQs <br /> IEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADURESS 21P PHONELS� B����7 <br /> <� sc_ {Zo�'v- s 2rs��r;. -� Z�l z3 �v/hv!/�v� �J`zo► <br /> TENANTNAME � I COHiACTFORPERMIT PHONE <br /> CONTRACTOR AODRESS 21P COHTR.UCENSE k <br /> 027C—C.� r� vl � a�2aiL'�ii�r' St3Y S L..�; �� .S�¢- sc.���/� �...r� 9�/1..4 <br /> PHONE 7UL � / L 3 9� C/ Z �M"`�cV �� � / �S <br /> PROPOSED USE OF BUILDING Building fl Mechanical Addition I HEAT SOURCE <br /> I PER:dT R Combinalion K Plumbing IWORK � AIte2Uon �) Electric <br /> TYPE D Demo�ition U Sign TYPE New D Gas <br /> U Sprinkler Repair/Maint. U Other <br /> CONTRACT PRICE OF WORH�Z S"vD.Q "C� CITY OF EVERE7T LOCAL SALES TAX CODE IS 7705 <br /> WORK DESCRIPTION <br /> f- t �^e S�Q�YC S'S!�ti.�— S}- ..S�'�i..� 1 �`S�� I�`�( Jl/L <br /> PLUMBING MECHAKICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> VJATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAI CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> rLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN , <br /> _ OTHER _ OTHER � vc yt"sSi�^'' s�"'�� � <br /> I HEREBY CERITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS DF LAWS AND ORIDINACES GOVERNING THIS TYPE Of WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR <br /> NOT. i HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR I.00AL LAVJ REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZFJ BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AMD 296.200 WAC. <br /> �tGG� o� t /L� <<,. �c vt�� a�� �T.4 � ti�y�0 y <br /> �ignature of Owner/Contracror/Authonzed Agent Date � <br /> lL <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />