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P�RMIT APPLICATIO"�V j <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.# PERhu7 tt <br /> 3G� ZS e� .e r�-�-�t-A,w� �'ot-/� - oo" <br /> LEGAL LOT NO. BLOCK TRACT <br /> IDESC. <br /> OWNER ADDRESS I ZIP PHONE <br /> Lr�t-r� �V��� �/1�L 2 ( 3Z E-I;�l, (a-.J ZS7--7�15� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � �lJr-��5 �e,��(:� S' `/7S -Z��-3y�(o <br /> CONTRACTOR V� C (� �S,� S (�S RESS a 36JC �.Zg�F[� IP a CONTR.LICENSEN <br /> �, � i� �- � �� G GU�-�-ir�o3 ZaS <br /> PH�JNE H"ZS' � Z� U- � �� �0 <br /> � PROPOSED USE OF BUILDING Building f� Mechanical Addition HEAT SOURCE <br /> PERMI7 RI--( Combinalion F_� Plumbing WORK Alteration R Electric <br /> p �_\_ n \ TYPE u Demolition LJ Sign TYPE New u Gas <br /> �lV � 1�•�'4�'. I S U Sprinkler RepairlMainL U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION �J�?� 1�\ � l-i��•�h �<<^^�ba's� }-pC �. I � �•^�'� �}� 6� Id��--•� - <br /> J <br /> PLUMBING MECHANICAL <br /> NO. I TYpE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET(TOILET) i�/C-AIHANDLING UNITS <br /> � BATHTUB FORCED AIR SYSTEMS <br /> �� LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> 10 KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> � DISHWASHER = RANGE HOOD <br /> � _ LAUNDRY TRAY _ WATER HEATER <br /> I ,j 0 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 I <br /> i — — i <br /> � — — <br /> I <br /> ; <br /> � � I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRFCT. ALL <br /> PROVISIONS OF L,1WS AND ORIDINACES GOVERNING THIS TYPE OF bti�ORK IVILL BE COMPLIED bVITH 1NHeTHER SPECIFIE7 HEREIN OR 'I <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION GF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I:.A7 AUTHORIZED BY THE I <br /> OWNER OF THIS PROPERTI'TO P�R:�RM THE WORK FOR WHICH APPLICATION IS MADE dN0 I COAIPLY WITH THE STATE �I <br /> i CON .RAC'ORS lAW 18.27 kCW i.ta0 296.200 WAC. <br /> , � ��— � /30�0� � <br /> Signature of OwnedContrectodNuthonzed Agent Date <br /> i <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED � <br />