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P�RMIT APPLICATIOrI <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS p <br /> � �� pARCEI.TAX I.D.# PERMIT# <br /> �Z03 S � �GVirL�I' h'1'�I� (..iA� I�LljOS _LI. OlFL- OObS' �'�� ��C�/ _ <br /> LEGAL LOT NO. BLOC!C TRACT <br /> DESC. Z�p PHONE <br /> OWNER ADDRE55 <br /> zY`` sT iS'cll� v�... 4�zs= 74�7- �$zs— <br /> �S {� �/ o Cr-ficS IyjjS� N�' PHONE <br /> TENANT NAME I CONTACT FOR PE2MIT <br /> �rr ch -(� � � % S S-F��` P�o l l�zr- 7Y7- /S zs' <br /> ADDRESS ZIP CONTR.LICENSE# <br /> CONTRACTOR ���rr N Go�/ C o <br /> /-'O. /3oX Sz 65 J3c.r'r�tNc�77cs.r <br /> PHONE y?i- 77�- Fsfr3 S— GYNN G.�jC.�� � S��yL <br /> Building Mechanical nddition HEAT SOURCE <br /> PROPOSED USE OF BUILDING Eleclric <br /> PERMIT Combinalion Plumbing WORK Iteration � Gas <br /> 7ypE Demolilion ign TYPE New <br /> �q-i r Repair/MainL . Olher <br /> Sprinkler <br /> CONTRACT PRICE OF WORK ,�fJ O o 0, °� I CI1Y OF EV[RETi LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIP7ION S j.J.v �-o N�-�/ L�`A ���"w/ <br /> Mo�c, {K�S/:� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ /�IC—A/HANDLING l�tJ1 fS <br /> BATHTUB _ FORCED AIR SYSTEAIS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT IIEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> FIREPLACEINSERT <br /> URINAL GAS FIREPLACE <br /> DRINKING FOUNTAIN GAS RANGE <br /> FLOOR DRAIN GAS PIPING <br /> BACKFLOW PREVENTER EXHAUSTFAN <br /> SINK(SERVICE/BAR/MOP/ETC.) — OTHER_ — <br /> OTHER — <br /> —� I <br /> I I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL I <br /> I NOTVITHOE GRAN NG OF A�ERIMIT DOESG OTEPR SUMEITO GPVE A TH�ORIN TO VIOLATE OR CANCEL THE PRCVISIONI OF ANY OTH�ER <br /> ISTA?c ilR LOCAL LAW REGULATWG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> ION'NER OF THIS PROPER TO PERF M THE JC.FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORSLAW 1 � RCW <br /> Sign of wnedContrectodAuthorized Agent Dale <br /> DEBIT & CREDIT CARDS ARE NOT ACCErtED <br />