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P RMIT APPLICATIO�N <br /> CITY OF EVERETT RERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> � l�0�105 -paS <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT# <br /> 3��y � ,�a � x�y7o7-c�z - aoc�-oo 4 5� <br /> LEGAL LOTNO. BLOCK TRAC'T/ �1� �f <br /> DESC. 1 � /�lw�.�7-s /�i h�5 J'ele���Fia� <br /> OWNER ADDRESS ZIP PHONE <br /> Case�.� K�e.�.c.l 3p14 Fnc�� A�e s� 9$zo1 �lZs-�sz -zo�lo <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> Snrv�z f.�S !��'C. I 1..0.b�� ��fGi�wr <br /> CONTRACTOR '$n..r.�, q., �� ADORESS 21P CONTR.LICENSE N <br /> SAmE A9 yy.,� <br /> PHONE jGl�w�; <br /> 42-5 -ZSL- Zo74 <br /> PROPOSED USE OF BUILDING pERM1T � Sp nklle�`ion R Plumb'ngai WORK �-( Repair/Main�, HEAT SE ectric <br /> TYPE Demolilion D sign TMPE �-t NeW u p her <br /> U <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION je�„r �lc�ti�� O�d p� Gctr Cj�.rn5�. u-�ISl�c�v <br /> �eb��a�d vl.cW �'W:. G:� C;_r�5e � s{.o�� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) AIC-AlHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEIvIS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER R,4NGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOPIETC.) EXHAUST FAN <br /> OTHER OTHER <br /> i _ <br /> i <br /> I HEREBY CERI?IFY THAT I HAVE READ 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 HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br /> I STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br /> iOWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND t COMPLY WITH THE STATE <br /> CONTRACTORS LAW�827 RCW AND 296.200 WAC. <br /> � �,ck�, �1�C�„o � r/�oy <br /> � Signature of wnedContractodAuthonzed Agent a'6� <br /> � DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED ,/2 <br />