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. �- --- ; <br /> PERMIT APPLICATION <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.M PERMIT A <br /> � QL �mes'�,n. - 1 _ ���-182 S-6� - ►�U -5� D/-C�/ <br /> LEGAL L;T�O. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS PHONE <br /> �h�-i5 �- e.r�ni G�r� ��6 0 i f�r'.� Na5 .5I3 . I°('8 <br /> TENANTNAME CO TACTNAME PHONE <br /> Chc�iS Ci �i� lo I �hr"�5 Cir�� �a 111�5 ,5(3 � 1�1'��-� <br /> CONTRACTOR ADDRESS CONTR.LICENSEk <br /> PHONE <br /> PROPOSED USE OF BUILDING Building � Mechanicai Addition HEAT SOURCE <br /> PERMIT � Combina�ion Plumb(ng WOflK R Alteration � Elactric <br /> TYPE Demoliiion S�gn TYPE D New Gas <br /> Sprinkler U RepaidMeinl Olher <br /> CONTRACT PRICE OF WORK ���� 7-- CITY Of'EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> �A�����ct, 04 �dd�r4'��\ R..e���r, � K';-�c1���� . - 3�� S F <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl7(TURE OR REM NO. TYPE OF fll(TURE OR REM <br /> _ WATER CLOSET _ A/C—A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTF.MS <br /> LAVATORY(WASH BASIN) _ HENT PUMP <br /> SHOWER _ UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER � RANGE 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/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 /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEfl SPECIFIED HEREIN OR <br /> NOT. THE GR TING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR L LAW REGU TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER T PROPERTY PERFO THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTi7A 0 LA�y 1827 R AND,2 6 0 WAC. , <br /> s�C .� �o O I CT '/a <br /> SignaWre of OwnedContractor/Authorized Agent Dat h �� <br /> ��V <br />