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i <br /> PERNiIT APPLICATIO� <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.# PERM " � <br /> !fD07 � �1UC- C�YD �bl /J - <br /> LEGA LOTNO. BLOCK TRACT � <br /> DESC. '2j-LI ^ I� ��� '( � �/��� <br /> OWNER A�ORESS <br /> ZIP PHONE <br /> "-17�C-2E�/� /`�LLf �1�L�7 CGLBY ttlx 4�Yz �1zs- z55- ��9� <br /> TENANTNAME I CONTACiFORPERIdIT PHONE <br /> /, 42�T. <br /> CONTRACTOR ���� �T�j �2�g'3-y�N �zy <br /> ADDRESS ZIP CONTR.LICENSE# <br /> ��I��Z!i +1�c-c �rt��cctc � �'�1C• ��-3v i�3'��t1UF„t�f. <br /> PHONE ����( ' , ^A, ��j� j4'1C-RI 1 V��I�Il/( <br /> W <br /> PROPOSEDUSEOFBUILDING Buildi�g dechanica� ACtlition HEATSOURCE <br /> PERtd1T R Combination Plumbing � IINORK`RI-1,AL'eraPon �lectric <br /> j .F R ` TYPE D Demolition Sign TYPE �g-Wew Gas <br /> U Spnnkler 'U RepainMaint. ther <br /> CONTRAC7 PRICE OF bVORK � ��� 1 �/ CITY OF EVERETT LOCAL SALES TlilC CODE IS 3105 <br /> (P <br /> WORK tlESC.RIPTION <br /> G<r1S �-O ��rf S f�f�L(?�IC� l�c-�cr1��--!'!1L-,��T <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPt OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> _ BATHTUB � FORCED AIR SYSTE615 <br /> _ LAVATORY(WASH BASIN) HE.4T PUt�4P <br /> SHOWER UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER tvMETAL FIREFLACE/STCVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUN7AIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOVJ PREVENTER GAS PIPING <br /> _ SINK(SERVICEiBAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER � OTHER r-sr�r ��tL <br /> — i <br /> I HcREBY CERITIFY THAT 1 HAVE READ AND EW+MINED THIS inPPLICATION nND KNOW TNE SAIdE TQ BE TRUE AND CORRECT, ALL <br /> PROVISIONS OF LAl"JS AND ORIDINACES GOVERNING TMIS Tl'PE OF N'ORK'�VILL BE CGM17PLIED WITH 1NHE-THER SPECIF!ED HEREIN OR <br /> NOT. THE GRANTING OF A PER�71T DOES NOT PRESUtdE TO GIVe AUTHORITY TO VIOLATE OR CANCEL THE PROVISIDN OF ANY OTHER <br /> STATE OR LOCAL LAW R[GUTATJ1c�G CONSTRUCTION OR TNE PERPOR!�tANCE OF CONSTftUCTION. THAT I Ah7 AUTHORIZED BY THE <br /> OWNER OF TNIS PR p RTY TQ- RFORId THE LYORK FOR l4�HICN APFLICATION IS 61HDE AND I CON,PI.Y WITH THE STATE <br /> CONTRACTOR LA ��27 C'W ;D 2P6.2001WAC. <br /> � <br /> / � . <br /> f1� <br /> Signature 0 d ontracto Authorized Pgent Date <br /> ; DE81T & CREDIT CARDS ARE NOT ACCEPTED � <br /> r <br />