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PERMIT �4PPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9F3201 <br /> 425-257-&d10- FAX 425-257-8857 n,l� ��� /- D(� <br /> Y <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI7# <br /> 5 0� �m �A A�� 00 5 5o c� i� o a� d d � �v�f -o�� <br /> LEGA LOTNO. BLOCK TRACT <br /> oEs�. a3 � a�1 oi � �N�r+u�,s-r �zv r3 <br /> OWNER ADDRESS ZIP PHONE ' Q7-7360 <br /> HA��.� 6�s, G�N�-r, 39aa 8���- N� �-� ��as <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> . -�oe� t�ao,�C �Izs-a9a �a�a9 <br /> CONTRACTOR ADDRESS_ ZIP CONTR.LICENSE N <br /> �� �3,�, c�NST, 3qaaa��r�pt,�. Nc 9t�aos ��Rr�ck���$,D <br /> PHONE — IZS� 3 1�".13�O� <br /> PROPOSED USE OF BUILDING Building D Mechanical Addition HEAT SOURCE <br /> S�� PERMIT � Combination I ) Plumbing WORK � Alteration � Electric <br /> IYPE Demolition p Sign 7YPE New Gas <br /> Sprinkler RepairlMaint. Other <br /> CONTRACT PRICE OF WORK 9 O�V U O CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> N �w SF (Z <br /> D � .Z <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C-AIHANDLING UNITS <br /> BATHTUB T FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL T CLOTHES DRYER <br /> DISHWASHER T RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> � CLOTHES WASHER � METAL FIREPLACE/STOVE <br /> URINAL FIREPIACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN � GAS RANGE <br /> BACKFLOW PREVENTER r"' 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 KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF LAWS AND ORIOINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED F'�REIN OR <br /> NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OW OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAUE AND I COMPLY WITH THE STATE <br /> CO TR CTORS L 1827 RC AND 29620 WAC. <br /> � Z Q <br /> Sig ature f wnedContractod.l zedA nt ate �� <br /> L <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />