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P�RMIT APPLICATIO�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 -- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.X PERMIT# <br /> �' � �'.3/Z-f�/� <br /> LEGA lOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER qDDRESS ZIP PHONE <br /> J���k � �� � � ��'n✓1 wouc� l�rJz �J�..e�� (,�JY-I �/'��'- U 3 <br /> TEN NAME CONTACT POR PERMIT PHONE <br /> - �1�,�,�PM y�s 3ys- 3�-i � <br /> CONTRACTOR �,�. (, ��SI���h��,"� I++c ADDRESS . ZIP CONTR, LICENSEII <br /> ss�3 Fr�-�,�,�� ALCpNl+ !`�'r3R% <br /> PHONE ZYJ.�.�C�..Y4 1S'�°Z6 3 <br /> PROPOSED USE OF BUILDING Building f1 MBChaniCal fl AddiOon HEAT SOURCE <br /> S���LE �A�'�'«Y PERMIT Combination K Plumbing WORK Cky�,Alteratlon Q Electric <br /> TYPE Demolition LJ Sign TYPE �j New pQ Gas <br /> �„�'�� �(„� Sprinkler U Repair/Maint. U Other <br /> CONTRACT PRICE OF WORK �� S U U CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> f I 1 <br /> WORKDESC!�RIPTION ,lt'��y� <<,,,.,, �p.����c��'"., (�c�,,,,,..C,�i� n`Jmb�h ct�vlJnr{.� •�VG to75 " <br /> 1 �-e-c--�c �a *�✓rra»t ` S�� � �..J � <br /> J}v., i OJnr�a-�i��� t c � � �� S i�n�C Y- �Z7t e �. <br /> �' SD StZ . FT. �o�VfatS o o►� n-aW Sp � 0 5 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �� WATER CLOSET(TOILET) _ A1C—A/HANDLI�G UNITS <br /> BATHTUA FORCED AIR SYSTEMS <br /> I� LAVATORY(WASH BA£IN) HEAT PUMP <br /> I_�[ SHOW ER UNIT HEATERS <br /> KITCHEN SINK R DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGEIi00D <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS R,4NGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) ��� EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND K\OW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISION5 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 PRESUAIE TO GIVE AUTHORITY TO V'OLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE UR LOCAL LA1N REGULATING CONSTRUCTION OR THE PERFORMANCE OF CC'NSTRUCTION. THAT I AM AUTHORI2ED BV THE <br /> OWNE.'2 OF THIS PROPERTY TO PERFORh1 THE WORK FOR WNICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> /,i�-.�k� �/- -ll.���t- � �,�/.��,/o � <br /> S gnaturo of Owner/Coniractor/Authorized Agent Dale �I y <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />