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PcRMIT APPLiCATII.rIV I <br /> � CITY OF EVERETT PERMIT SERVI�ES <br /> 3200 CEDAR STREET, EVEkETT, WA 98201 <br /> 425-257-8810 — FAX 125-257-8857 I <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# i <br /> rnosra- o <br /> LEGAL LOTNO. BLGCK TRACT <br /> DESC. <br /> OWNER A�DRESS l���p ZIP PHONE � <br /> j7`�v�,:.� �L��GI�a� � l0 �/ S�.L:. Lo=e.u�l7/�lU//GCay `/ZS- 3'�7- % 7 "l J <br /> TENANT NAME CONTACT FOR PERMIT _—� PHONE <br /> $'< »� e <<� li!/sf4 �% �/zs -�3�—/ 7zE' <br /> CONTRACTOR A�DRESS ZIP CONTR.LICENSE# <br /> �yi���',, s��,s f ��,�, «.r, � 3ioc �_��,��-rr �� �y,�9ti�ss o vL,�z <br /> PHONE -{,� �r¢ <br /> �/15- Z7 %- 2 ��� �'�/ev�LG/ �IV ���� <br /> PROPOSED USE OF BUILDING n Building �Mechaitical Adtlition HEAT SOURCE <br /> PERMIT [� Combina�ion Plunlbing WORK Alteratinn � Electric <br /> `C����/� TYPE D Demolition Sign rvPe New �as <br /> " 1 U Sprinkler RepaidMainL Other <br /> CONTRACT PRICE OF WORK ` �/ � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION p <br /> /1 c' fi'D �a�f f/' cli�i �� <br /> L- �/CC � /�'ind , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C-AIHANDLING UNITS � <br /> BATHTUB Z FORCED AIR SYSTEMS <br /> LAVATORY!WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> I DISHWASHER RANGE HOOD <br /> li _ LAUNDRYTRAY _ WATERHEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE I <br /> FLOOR DRAIN GAS RANGE ' <br /> _ BACKFLOW PREVENTER � GAS PIPIMG I <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN I <br /> _ OTHER_ _ OTHER � <br /> I <br /> — I <br /> i — — <br /> � — - — I <br /> i <br /> I HEREBY CERITIFY THAT I NAVE READ AND EXA�dWED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL I <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING l"HIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPFCIFIED HEREIN OR � <br /> �� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY'TO VIOLATE OR CANCEL THE PROVISION OF FNY OTHER <br /> �� STATE OR LOCAL�W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION, THAT 1.�M AUTHORI2ED BY THE <br /> I OWNER OF TH�S PROPERTY TO PERFURM1I THE SNORK FOR WHICH APPIICATION IS MADE AND I COMPLY WITH THE S'ATE <br /> CONTRACTORS LAW 1827 RC'N AND 296200 WAC. <br /> � i <br /> ,��. <br /> a � <br /> � ��/ / l�// : �Z- 7-C� -OJ <br /> iSigneWre of OwneriContractor/Authorized Agent Date I <br /> � DEBIT & CREDIT CARDS ARE NOT ACCEPTED I <br />