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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SER'VICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 42L5- 57-8857 <br /> OD3�S/ l DG�/G�� <br /> SITE ADDRESS ���f2�� l�"P� `f��,j PARCEL TAX I.D.# PERMIT« <br /> � i i� f�n ' �5 -O/lO <br /> LEGAL LOT NO. �f BL� CK ACT �S'��(� � <br /> �ESC. � I G, n e. �7?� 3 <br /> OWNER _�� �IP PHONE <br /> ��N - I'ia�..��i C� ���A,v> > c��,�- 1l n�m� ��,��,�'"„ <br /> TENANTNAME CONTACTFOR RMIT PHONE � <br /> � ti( � .�� I�.,����� i��IEZ � Sr�rnt. ��o- 77a-�I�IJ`i <br /> CONTRACTOR " ADDRESS ZIP CONTR. LICENSE# <br /> �'Y�I.A'CioS �S�"Yu�i'fe1^.. <br /> PHONE � ���c�� .,` c n�t � -� ���a3 pAl,�c�-�T�l cs�. <br /> ..� �?, '�- S�K- c�S�) a-Y .- �� le, � '� �— S7r�t 5-1�1� i1ti-1,� �t�t,,;� <br /> PROPOSED USE OF BUILDING Bu�lding f'1 Mechanical AddiUon HEAT SOURCE <br /> PERMI'f ��Combination F_� Plumbing WORK R Alteralio� � Electric <br /> TYPE Demolition LJ Sign TYPE D New Gas <br /> ��il fli rt^ .5����n� Sprinkler U RepaidMaint. Other <br /> COn�TRACT P ICE OF WORK ��/�)� — CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> �Yannm�j � �I�c��'��ct� .v ��G�rG_pl.e , �;� cv;-w�;-I-io,,,-r�-� vp�Jrc�c�� , <br /> I�1 ���v.��r <br /> P UMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE ORjTEM � <br /> WATER CLOSET(TOILET) �_ A/C—AIHANDLI UNITS <br /> BATHTUB FORCED AIRy� STEh1S <br /> X LAVATORY(WASH BASIN) HEAT PUMP/ <br /> SHOWER / UNIT HEA kRS <br /> KITCHEN SINK DISPOSAL CLOTHE DRYER <br /> ISHWASHE NG OOD <br /> UNDRY T AY WA HEATER <br /> X CL HE ASHER ME AL EPLP.CE/STOVE <br /> URIN F EPLAC_ SERT <br /> DRIN FOUNTAIN AS FIREPLAC <br /> FL�R OR GAS RANGE <br /> B CKFLOW P VENTER GAS PIPING <br /> >C �NK(SERVICE/ PR/MOP/ETC.) EXHAUST FAN <br /> � OTHER _ UTHER <br /> I HEREBY CERITIFY THAT I HAVE RE�D AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED 4EREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh7E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVIS!ON OF ANY OTHER <br /> STATE OR LOCqL LAW REGUEATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTFiOR12ED BY THE <br /> OWNER OF THIS PROPE�R3`Y T� PEFjF !v1 THE WORK FOR WHICH APPLICATION IS ADE AND I COMPLY LVITH TH�STATE <br /> CONTRACTORS LAW� 2bRC A 9G.200 WAC. <br /> � , 5 � 6 `/ <br /> Si nature of OwnerlConCra r/A horized A ent ate � <br /> 9 ���� DeBIT & CREDIT CARDS ARE N� ACCEPTED I/Z <br />