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P�RIViiT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES / <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ( � <br /> 425-207-8810- FAX 425-257-8857 I <br /> � --16 -05 ; <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT» � <br /> � I 3 � S� �U('I'�'�lF���� l(JA S`�Z��'ri�i� � <br /> LEGAL LOTNO. BLOCK RACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE � <br /> I <br /> TENANT NAME CONTACT FOR PERMIT PHONE I <br /> �fi�S;�1A1�fi �;ll BU/+Y ;6v :,, �- �a 9� i <br /> CONTRACTOR � ADDRE55 ZIP CONTR.LICENSE# <br /> ��p� -/-ol s;y�v �� �h�,y� �r�� �t�. ��,r E3ioG 1_���1,�� CAPzrSA �z � �l <br /> PHONE �b�, r-I/ 7- ���U �t� S� 1 <br /> J <br /> PROPUSED USE OF BUILDING Building I� Mechanical Addition HEATSOURCE <br /> PERMIT � COmbinatiOn +_�Plumbing WORK �Alteration � Electnc <br /> ��� S�f"'U rF 7YPE Demo!ition aQSign 7YPe New Gas <br /> Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK �1 I� (�, � a� CITY OF EVERETT LOCAL SALES TAX CODE IS 31�5 <br /> Ir <br /> WORKDESCRIPTION �---+— �Y�'-�J S! NS F.F A-rl �-� 7�"' -�1-�"�'^�f�(�}_C <br /> -h'-a Z�.� � � � <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATERCLOSET(�OILET) _ A/C-AIHANCLINGUNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HFAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br />_ LAUNDRYTRAY _ WATER HcATER . <br /> CLOTHES WASHER _ METAL FIREPLACEISTOVE �� <br /> URINA� _ FIREPLACE INSERT � ,�- <br /> DRINKING FOUNTAIN _ GAS FIREPLACE ��� <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING (��, <br /> � — SINK(SERVICE/BAR/MOP/ETCJ _ EXHAUST FAN , � ` ! <br /> OTHER _ OTHER ` <br /> _ _ , ��Y� <br /> , _ _ �� <br /> � - �� _ <br /> � � � <br /> I HEREBY CERITIFY THAT I HAVE READ A�D EXA�•11NED THIS APPLICATION AND IWOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF LAWS AND ORIDINP.CES GOVERNING THIS TYPE OF NJORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> '� NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRQVISION OF ANY OTHER i <br /> �� STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFCRNANCE OF CONSTRUCTION. THAT I AM AUTHOR¢ED BY THE II <br /> 'I OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS AW'IB.27 RCW AN 29fi.2�0�NAC. / � <br /> i ��//l � � � � �9 Z.� u; <br /> ���/ <br /> � Signature of OwnedContractorlAuthonzed Agent Date �I <br /> I DEBIT & CREDIT CARDS ARE NOT ACCEPTED `L <br /> i <br />