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-- - —� -- - _S ___------ <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES '1i�'�� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> 3 � .�6 fD <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI7# <br /> III 2 �RG,,p�,., t,.�`r �4qL9oo3oo"ioc� S / a�3 �06 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS Z12 PHONE <br /> o'REtCI.Y ,htffo Z33 P��fa2S��J ST . SPR-�Nc,�+�.o� v�� �&�3 <br /> TENANTNAME CON7ACTFORPERMIT PHONE <br /> D`►Q-�l.`�f ,AuT.� I S H.�wN r3ow �1 <br /> CONTRACTOR --rJ�_��T AD�RESS ZIP CONTR.LICENSE p I <br /> 1��7 L{'C►�,A�. S . S�T��� t�A S <br /> PHONE 9 6 �3 q TJQt��lfl�3� <br /> 2o�22'a I �Z2 <br /> PROPOSED USE OF BUIL�ING Q Building Mechanical I Additlon HEAT SOURCE <br /> PERMIT �_) Combination R Plum6ing WORK�Iteralion (� Electnc <br /> p,��� TYPE D Demolilion '�Sign TYPE ew D Gas <br /> �'� U Sprinkler I Repalr/Maint U Other <br /> CONTRACT PRICE OF WORK �� ' ,p�o s CIN OF EVERETT LOCAL SALES TAX CODE IS]105 <br /> WORK DESCRIPTION <br /> (N S'Co-�-L- T�-c�r "- Ir-�P`�'t S'�Lv.1 S . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) iVC—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMP, <br /> LAVATORY(WASH BASIN) HEAT PUNP <br /> SHObVER UNI I'HEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY INATER HEATER <br /> CLOTHES WASHER METAL FIREPIACE/STOVE <br /> URINAL FIREPLACE INSERT � <br /> DRINKING FOUNTAIN GAS FIREPLACE � <br /> FLOOR DR.41N GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICElBAR/MIOP/ETC.) EXHAUST FAN <br /> OTfiER OTHER <br /> I HEREBY CERITIFY THAT I HAVE ftEAD AIJD r.�lMINE�TMIS APPUCATION AND KNOIN THE SAh1E TO BE TRUE AND CORRECi. ALL <br /> PROVISIONS OF L�WS AN�ORIDINACES GOVERNING THIS TYPE OF WORK 1NILL BE COIv1PLIE0\NITH WHETHER�PECIFIcD HEREIN OR <br /> INOT. TH'c GRANTING OF A PERh11T DOES NOT PRESUhdE TO GIVE AUTFORITY TO VIOIATE OR CANCEL THE PRO19510N OF i.NY OTHER <br /> 5TATE OR LOCAL LALV REGULATING CONSTRUCTION OR THE PERfORMANCE OF CONSTi<UCTION. THAT I AA1 AUTHORIZED BY THE <br /> ONRJER OF THIS PROPERTY TO PERFORAI THE WORK FOR�VHICH APPLICATION IS M11ADE AND I COMPLV WITH THE STATE <br /> CONTRACTORS LAVJ 78.27 RCW AND 29fi200 N'AC. ��,ZS• ' � <br /> '_—�—_—____. . <br /> Signature o� dC trac �Authorized Agenl Date �/ <br /> DEBIT& CREDI i CARDS ARE NOT ACCEPTED z <br />