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_ . ,-- - — --- --- -- --- <br /> � P�RMIT APPLICAl'ION l� <br /> CITY OF EVERE.'fT t ERMIT SERVICES <br /> 3200 CEDAR STREFT, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> I <br /> SITE ADDRESS PARCEL TAX I.D.# PERhuT tt i <br /> �oc�_�� rt�z�s- n�Hc� urn � � Qo3 �5-0� � <br /> �_��;.:_: LOT NO. BLOCK TRACT <br /> C'eSl I <br /> OWH�fFt ADDRESS 21P PHONE I <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �c��e�J +-�2.or-�s���S KF'-iTH h1�1siQ� -z.o� -�130-]�_ <br /> LJNT'WILTOR ADORESS ZIP CONTR.LICENSE# , <br /> F�teLCO e�F2p2�:s�5 ��. zqs31 5� 45�+� wR'f r-��"Lco�zo�,�r1 � <br /> aHorie I <br /> -zc)b -G30 -71qd rSS�aQ�*�N r�lA 9't�2`1 <br /> PROF�OSED USE OF BUILDING � .�KY(-Bu.lding C, �.10chanital Add�Gon HEAT SOI�RCE <br /> PERMIT I > Combination I ) Plumbing WORK �Alloration � EI^qnc <br /> TYPE �_� Demolidon [� Si�n TYPE New Gas <br /> Q��� � LJ Spinkl0� RepairlMai�t. Other <br /> CONTRACT PRICE OF 1YOFiK� 5 ^�� CITY OF EVERETi LOCAL SALES TAX CODE IS 7105 'i <br /> lJ I�r <br /> 1VORK�ESCRiFTION � <br /> � <br /> 2�lOGA16 � W�1CL � � Dl�e . <br /> — PLUMBING MECHANICAL I <br /> N0. �i TYPE OF FIXTURE OR REM NO. TYPE OF FIXTURE OR ITEM �I <br /> ' Y/ATER CLOSET(TOILET) _ WC–A/HANDLING UNITS � <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHONlER _ UN�T HEATERS <br /> KITC4EN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> IAUNDRY TRAY ,_ WATER HEATER <br /> � CLOTHES Y/ASHER METAL FIREPIACE/STOVE <br /> URINFL _ PIREPLACEINSERT � <br /> DRINKING FOL'NTAIN GAS FIREPLACE <br /> F�OpR DRAIfJ _, GAS RANGE <br /> � BACKFLOV! PREVENTF•� _ GAS PIPING <br /> SINK(SERVICEIBAR/MOPIETC.) _ EXHAUST FAN <br /> GTHER _, OTHER <br /> —I _ _ <br /> _I <br /> I <br /> � -=°c8V CERIT{FV THAT I HAVE READ AND ERn1.1UiED TMIS APPLICATION AND KIJOW THE SAPdE TO OE TRUE AND CORRECT. ALL <br /> --- .�:iSIONS OF LAWS AND URIDiNACES GO`leRNING TMIS TYi'E OF WORK WILL AE COMPLIED WITH WHETHER SPECIFIED HEREIN OR I <br /> " TME GAhpTiNG OF A PER64T DOES NOT PRESU�dE TO GI'/E AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> :.TE OR LCCAI lr.W REGUI�TING CONSTRUCTION OR THE PERFORMP.NCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY 7HE <br /> .:.ticR OF THIS PP.OPERN TO PERFORM�iHE YlORK FOR WHICH APPLICATION 13�AADE ANU I COMPLY WITH THE STATE <br /> ,�.`iTRACTORS LAY/ 1B 27 RC'!I A!�D 296200'!lFC. <br /> 1�---Q �`� c�s - ZS`b� <br /> Si9naiur o OwnenContrar,tonAuthonzeA Agent Date <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />