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r � -- <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT S�ERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 �/� Pt�;_/ <br /> 425-257-8810 - FAX 425-257-8857 � � <br /> ,Q63/d-03� <br /> PARCEL TAX I.D.# PERMIT# <br /> SITE ADDRESS m o3�1-�a <br /> ' U`3 5� ��Pre�i YY�+ <br /> LE6AL LOT N0. <br /> BLOCK TRACT <br /> DESC. Z�p PHONE <br /> AD�RESS <br /> OWNER <br /> TENANT NAME I CONTACT FOR PERMIT <br /> PHONE <br /> �/�iR • /'/ �S, �!�-1 /1�`'C_%GS,�e� �L�� 88s-3 zsf� <br /> ADDRESS ZIP C NTR.LICENSE# 6 <br /> LONTRACTOR �/ �{ <br /> 11�.e-rr,�2a6Q <br /> PHONE �F� ��IIiV.S�� � �x�Gh� V`�fF r( a"� W/4. I b0/`� <br /> Building �r�A eChanical Addilion HEAT SOURCE <br /> PROPOSED USE OF BUILDING L! � WORK AlteraUon Q Eleclric <br /> PERMIT R CombinafiorY�j r�umbing ,�PE Ne�� �j Gas <br /> 7YPE D Demolition U Sign Repair/Maint. U Olher <br /> //'�/ U Sprinkler <br /> !r"' � ��/a CITY OF EVERETT LOCAL SALES TAX COOE IS 7105 <br /> CONTRACT PRICE OF WORK �8 j 6 � / �f— <br /> WORK DESCRIPTION LG �ad u'S �� ��!/� ��0�'�i <br /> ��/��/ <br /> �/A�f� �GGS.� J`,�*/�f/ <br /> MECHANICAL <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM <br /> NO. . TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A�C—NHANDLING UNITS <br /> FORCED AIR SYSTEMS <br /> BATHTUB HEAT PUMP <br /> — L4VATORY(WASH BASIN) — U�l1T HEATERS <br /> SHOWER CLOTHES DRYER <br /> KITCHEN SINK 8 DISPOSAL — RqNGE HOOD <br /> DISHWASHER WATER HEATER <br /> — LAUNDRY TRAY — METAL FIREPLACE/STOVE <br /> CLOTHES WASHER FIREPLACE INSERT <br /> URINAL GAS FiREPLACE <br /> DRINKING FOUNTAIN — GAS RANGE <br /> FLOOR DRAIN GAS PIPING <br /> BACKFLOW PREVENTER — EXHAUST FAN <br /> SINK(SERVICE/BAR/MOP/ETC.) — pTHER�— <br /> OTHER�— <br /> '— � � � <br /> I I HEREBY CERITIFY THAT I HAVE READ AND EXAMINEU THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> S ATE OR LOCALILAW REGULATIING CONSTRUCTION OR T�HE PERFORAO NCE OF CONSTRUOCT ONNC HAT I AM AUTHORIZ�DABY�TE ER <br /> �ONTRACTORS LAW P8.2 RCW AND 96 2 0 W CORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> /f�/� G3 <br /> Signature of OwnedContractodAuthorized ent <br /> ate <br /> p IT & CREDIT CARDS ARE NOT ACCEPTEQ �f Y�('j 3I (�b � <br />