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7- <br /> � _" <br /> ERMIT APPLICA ON SHsr : <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � ��- O�'S <br /> 425-257-8810— FAX 425-257-8857 n� 3/ � <br /> �J O - d( <br /> SITE ADDRES PARCEL TAX I.D.# PERMIT# '� <br /> �U7 ' �VLr'ef�' �Vt. D '� 9/!0 /0��30/ C 0.3 //-0(7� <br /> LEGAL LOT NO. BLOCK TRACT <br /> oEs�. ��/�/S (o l!� Ci- O! <br /> OWNER ADORESS ZIP PHONE <br /> ��j�p�� /7ec�,� E .�9/? - �'edar ��c �Utrcfl; Wl`l 90�0(0 <br /> TENANTNAME rT I CONTACTFORPERMIT PHONE <br /> L��rc.r,ro �vtnver I ,(j,�a� Jo��vsoiv ,3lv0 - (�S/- ���'o <br /> CONTRACTOR J ADDRESS , ZIP CONTR.LICENSE# <br /> PHONE lJl�? ' ` /p �a^� <br /> 7 '�� T <br /> PROPOSED USE OF BUILDING Uilding Mechanical I7 Addition HEAT SOURCE <br /> - `��� PERMIT �Ombinati0n � Plumbing WORK 17r'Alteration Electric <br /> Espr�fJo C1 TYpE DefnClitiO� Sig� TYPE « New �'Gas <br /> Sprinkler V Repair/Maint. U Other <br /> CONTRACT PRIC'e OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> W ORK DESCRIPTION ,f'I I'U U l U�L <br /> (�i�� �rSParcc.�-io�t., Pqvii✓�o , ai✓c� s�a��L ca� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �NATER CLOSET(TOILET) _ AIC—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> I = URINAL = FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> I _ FLOOR DRAIN = GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> � SINK(SERVICE/BAR/MOP/ETC.) __ EXHAUST FAN <br /> � � OTHER � O HER f /AC <br /> l � � . o��v�' <br /> i <br /> � — <br /> II I HEnE6Y CERITIFY T' T I HAVE READ AND EXAMINED THIS APPLICATION AND KNOV:THE SAME TO BE TRUE AND CORRECT. ALL <br /> i PROVISIONS OF LAW ND ORIDINACES GOVERNING I�HIS TVPF OF WORK WILL 8F.CJMPLIED WITH WHETHER SPECIFIED HtREIN OR <br /> ' NOT. THE GRANTING A PERMIT OOES NUT PRESUME TO GIVE AUTHOFiiTY?O v'OLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> i STATE OR LOCAL LA GUTATING CONSTRUCTION OR THE PtRFVRi.iA•":CE JF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF' PRO E TY TO PERFORM THE WORK FOR WHICH AP ICAT N IS MADE A���D I COMPLY WITH THE STATE <br /> i CONTRA OR LAW 8. 7 RCW AND 296.200 WAC. <br /> � U <br /> Signature of nedC� trecror! u onzed Agent D e <br /> / DEBIT & CREDIT CARDS ARE NOT ACC EPTED ��� <br />