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P�RMIT APPLICATIan) <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVEF2ETT, Wq gg201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> I <br /> SITE ADDRESS /' PARCEL TAX I.D.# <br /> 0 �/ 4-v�� C��I^ PERMIT# <br /> 1... \ M o�{r��-c3 7 <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> WNER ADDRESS <br /> La�P���C�n�,�. L � O r/� t' ��U� ZIP PHONE <br /> J 1 '1�JO` II /� � //VNS'� G� OOO�/ �ILS -7 <br /> TENANT NAM I CONTACT FOR PERMIT ! �9'�S <br /> / 1������ �� PHONE <br /> l�l �C.a7E'Q(_ <br /> CONTRACTOR \_ 1 ` I <br /> �G C r\�l�C?4Cu l ADDRESS ZIP CONTR.LICENSE# <br /> PHONE ���e���CS � <br /> 253 �y�` -Sy� <br /> PROPOSED USE Of BUILDING Buildin I <br /> 9 Mechanical r, Adtliiion HEAT SOURCE <br /> PERMIT Comhination � Plumbing WORK �F-(( Alteration <br /> TYPE Demolition Sign 1YpE �,j New Q Electnc <br /> Sprinkler Ll Gas <br /> U Repair/Maint. �� Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODF IS 3105 <br /> WORK DESCRIPTION � ���� � �2 "_ <br /> 6f <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM I <br /> NO. TYpE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> _ BATHTUB FORCED A�R SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER — <br /> _ KITCHEN SINK 8 DISPOSAL _ UNIT HEATERS <br /> DISHWASHER CLOTHES DRYER <br /> LAUNDRY TRAY _ �NGE HOOD <br /> CLOTHES WASHER _ WATER HEATER <br /> URINAL _ METAL FIREPLACE/STOVE <br /> DRINI<ING FOUNTAIN _ FIREPLACE INSERT <br /> _ FLOOR DRAIN _. GAS FIREPLACE <br /> BACKFLOW PREVENTER _ GAS RANGE <br /> = SINK(SERVICElBAR/MOP/ETC.) — GAS PIPING i <br /> OTHER EXHAUSTFAN <br /> OTHER <br /> _ I <br /> i <br /> �I PROVESIONS OIFILAWS ANDHORIDINACES GOV RNING TH S TYPE OF WORK IVIDLL BE COMPLSED W T�WHETHER SPEC�'.FIED EREIN OR <br /> NOT. 7HE GRANTING OF A PERMIT�OES NOT PRESUM1fE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> , STATE OR LOCAL L.1W REGULATING CONSTRUCTION OR THE PERFORM1IANCE OF CONSTRUCTION. THAT I AIv1 AUTHORIZED BY THE <br /> I OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH AF? <br /> � CONTRACTORS LAW 18.27 RCW AND 296200 WAC. LICATION IS MADE AN�I COMPLY WITH THE STATE <br /> I �, Z �,� / <br /> I J <br /> Signature of OwnedContractor/Authorized Agent Date <br /> DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />