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:�i <br /> P RMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> .��107 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> -��'�= l!�12GRE��v t� A- � 5 l OC�c: �30 .3� � <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. _ I <br /> OWNER ADDRESS ZIP PHONE i <br /> ���r���c L�-�uE OF"E:(�`a�� 5�: tv�6,���w r.��Y y�5-zs".�-30�� I <br /> TENANTNAME CONTACTFOF.PERMIT . P ONE <br /> Gu�1 `s ��GrFr��iCz 31�v�� 3s -z��i �/ <br /> SRI� RS AKo u E '� __� � <br /> CONTRACTOR�puGS/�fA//VTEN�wC�ADDRE�S J��S_�9Y45 $�NE ZIP CONTR.LI;t�JSEp <br /> L.t G FfTS 2 SiE..�/5 �1 i n cJ�na (.o c� • 98223 <br /> PHONE <br /> 3(v o �- �y3 S-2o g �f �5 U�s F.4'-I ► 13 �T <br /> PROPOSED USE OF BUILDING Building �Mechanical Addifion HEAT SOURCE <br /> PERMIT � Combination PlUmbing WORK �Allerelion � ElecVic <br /> 7vPe Demolition Sign TYaE New Gas <br /> Sprinklef Repair/Maint. Other <br /> CONTR�Ci'PRICE OF WORK ��J/// � CITY OF EVERETT LOCAL SALES TAX CODE IS 9705 <br /> WORK OESCRIPTION , ��^ <br /> 1 �15 1 l�l,l,�f'i/n,v �oL L' ScC�n� f /UON -H�tM�nA.`I-�d�ON S�-d� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE QF FIXfURE OR ITEM NO.. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) AIC—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SFIOW[R UNIT HEATERS <br /> Y.ITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RAMGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE I <br /> FLOUR DRAIN GAS RANGE <br /> BACKFLOV'! PREVENTER GAS PIPING <br /> _I SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER . <br /> � <br /> T <br /> 'T <br /> I H REB1'CERITIFY THAT I H�VE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIO�!S OF lAWS AND JRIDINACES GUVER�IING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTI":G OF P,PERMIT DOES NOT PFtESUME TO GIVE AUTNORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTi.�N OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM.4UTHORIZED BY TNE <br /> OWNER OF THIu PROPERTY TU PERFORM THE WORK POR WHICH APPLICATION IS MADE AND I COMF'LY WITf�THE STATE <br /> CONTRACTORS LA1N 18.27 RCW AND 296.200'NAC. <br /> ��u�-� � �iv`� E- z,- �3 <br /> Signature OwnedContrectod uthonzed Agent Date i/ <br /> 2• <br /> I DEBIT 8 CREDIT CARDS ARE NOT ACCBPTED <br /> � <br /> �,: <br />