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�'ERMIT APPLICA�'JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-88�0 — FAX 425-257-8857 <br /> SITE ADDRESS ���� PARCEL TAX I.D.N P IT x <br /> 1. c� l z �� v •�-�r� �, " I� - b� � ' <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �)-+e L� S \•c� ti-t.� 1 a � ' � � ,C � � �c' Y ���; `�' (`v�� <br /> TENANT NAME CUNTACT NAME PHONE <br /> � �,�,<C' ts`•L��S n�Ot � �� � V �O - Z �r 3 �' � � f <br /> CONTRACTOR .� ADOflESS �`, LP CONTR.LICENSEM <br /> � � b -� T � � ` j p. �.2 -�t rS ° <br /> .3 � `�� .� { L�� . r 1�' P � '. � i <br /> PHONE C�'�i t 11 O � J� <br /> � n � � � � � � ��� � � <br /> PROPOSED USE OF BUILDING 8ui ng a�y.�M�echanical � 4ddition HEAT SOUFiCE .`�',t <br /> � PERMIT R{-( Combine�ion � Plumbing y IWORK Alteralion nH Electric � <br /> � � $ � �,l(� � ��� TYPE �f Demolitian Sign TYPE New �( Gas <br /> L� Sprinkler RepairiMaim. L� Other <br /> CONTRACT PR�CE OF WORK ) y�1 4 � ,� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> [ ( <br /> WOHKDESCRIPTION G � � �� � f_ <br /> � p'e G"i <br /> I � YL �T � '�,� l-� � e � ��Y'1 lC�� � V <br /> j PLUMBING MECHANICAL <br /> � NO. TY?E OF FIXTURE OR REM NO. TYPe OF Fl7(TURE OR ITEM � <br /> WATER CLOSET _ A/C-A/HANDLWCi UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> I.NVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK& DISP03AL CLOTHES DRYER <br /> _ DISHWASHER �, RANGE HOOD <br /> I = LAUNDRY TRAY = WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE iNSERT 1 <br /> = DRINKING FOUNTAIN GAS FIREPLACE � <br /> � _ FLOOR DRAIN _ GAS RANGF <br /> BACKFLOW FAEVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMWED THIS APPLICATION AND KNOW THE SAME TO 0E TRUE AND CORRECT. ALL I <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPUED WITH WHEfHER SPECIFIED 4EFEIN OR i <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY CTHER � <br /> STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR�IZ �Y THE � <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH TNE STI+TE ��' <br /> CONTPACTORS LAW 18.27 FCW AND 296200 WAC. /1 '1 /// . <br /> GYV�^ Z1,LA rLA,Kt,Lv'�-- r � 1 a 1 •,.� / �i/� � ' <br /> Signature o�OwnedContractodAuthonzed Agent ate � �Y(.y � . , 1�L <br /> � � , <br /> � s �T �.� rs �^� � S � r� ,� ,_`__ <br />