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- � , -� <br /> P�RIVIIT APPLICATION <br /> CITY OF EVERETT i�ERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 <br /> SITE ADDRESS lOS 19 �1�Ko t7�t WA'f pqRCEL TAX I.D.# PEP. IT� I <br /> �v�c-n.E-�r, w,a �g zv �/ ol�ssz� �� os�'��6Z 02�' <br /> LEGAL LOTNO. BLOCK TRAC1� <br /> DESC. (,NC- J �d f�' D ��, �Pcr/ <br /> OVyNER ADDRESS ZIP PHONE <br /> TEp•a-/IIA/'�G�7r?c�T LC�£�fi! /�/! �/)i�'ff1 ('.UR� �fs �l�?�T7� tU�i Q�l?�� ��"1C=7-�%O/�/��� <br /> TENANT NAME CONTACT FOR PERMIT PHONE i <br /> t—���/�,C'F,�',�!—T �.U���`'—� I Y�t�Y l�>rEsh'�1r��£�L',� i�'l-S�1`f'�>/5�7�0 <br /> � <br /> CONTRACTOR 0(���2� ADDRESS ZIP C9NTR.LICENSE p <br /> PHONE <br /> PROPOSED USE OF BUILDING r62f Buiiding I� Mechanical �'Addition HEAT SOURCE <br /> PERMIT '�_�Combination �_� Plumbing WORK K�Alteration J Electnc <br /> TYPE G...j Demolilion �� Sign 7YPE �� New „r� Gas <br /> ��lyC� v Sprinkler l� RepairlMaint. �y Other <br /> CONTRACT PRICE OF WORK �S�i�j oc CI1Y OF EVERETT LOCAI SALES TAX CO�E IS 7105 <br /> WORKDESCRIPTION �i�L �tRL,,�����on� Fi�rq�)1L� S/fX P�� OGf �/�'✓�+�Ti9��D <br /> �2 Sr;X Z,Y f��'AC-r <br /> PLUMBING MECHANICA� <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TO�LET) PJC-A/HANDLING UNITS <br /> � BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> i _ KITCHEN SINK&DISPCSAI _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STUVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/BARIMOPlETC.) EXNAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND E.`WMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. PLL <br /> I PROVISIOtvS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED N'ITH WHETHER SPECIFIED HEREIN OR , <br /> NOT. THE GRANTING OP A PERMIT DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOtATE OR CANCEL THE PROVISION OF ANY CTHER i <br /> STATE OR LOCAL LA�V REGULATING CONSTRUCTION OR THE PERPOR61ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PcRFORM THE SYORiC rOR WHICH APPLICATION IS PdADE AND I COMPLY WITH THE STATE I <br /> CONTRACTO LAjN.7 �77� R e,ND 296.200 WAC. � <br /> �/�I'� �✓�j�/��, , / �-/��L/ I <br /> S�gnaWre'of ner�ConlractodAulhonz -Agent Date `�i I <br /> � DEBIT & CREGIT CARDS ARE NOT ACCEPTED � <br />