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�� � IL�a� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDkESS PARCEL TAX I.D.# PERMiT# <br /> a �19 Lorhg�D A1/� a�-E� � ,go� ��� �y��-�� <br /> LEGAL LOTNO. BLOCK \ TRACT <br /> DESC. ID � (�. � U-O <br /> OWNER ADDRESS ZIP PHONE yt� <br /> �R.��. £ ,�Z� rc� S'm�l�, al�q Lo�8aQ0 Av2, °/8Zc7 ( Zsg - ��Sg <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ��e-�� �,���.s ve�: <br /> � S�rme, I /�ar3� / �vih„�,�1�')��a) � 68 -ao�c� <br /> CONTRACTOR K��(j�J/L C�5 i/LIJL?7�JV) ADDRESS /D��C� �N�A��A f�n ZIP CONTR.LICENSE# <br /> ��model�� £ /�-p�,12 i�. '/_ / �y� Fo /1�r���PP <br /> PHONE r3�0(�� IO�Og��DO SNf7ryUMiS�1 u�ra- 9�Zy� K Ul�- <br /> PROPOSED USE OF BUILDING Building I"") Mechanical Addition HEAT SOURCE <br /> PERMIT �Combination �-� Plumbing WORK Alteration � Electric <br /> TYPE Demolition Ll Sign TYPE w Gas <br /> S�� Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION ;� � _ _ _�� ��„ /� —�'� �xr5r��(� 5i1n,p L� <br /> -Y' ��� rN � � <br /> -�,�i�c.� res i c��wc� _ Sc�P� �N I�n�n �c.-F- �,-s ��M-2 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. . TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTE��1S <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISH�VASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLRCE INSER'i <br /> DRINI(ING FOUNTAIN vAS FIREPLACE <br /> FLOOR DRAIN GAS RA�Gc <br /> BACKFLOW PREVENTER GAS PIPING <br /> i SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER_ <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES CaOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOI.ATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW'1827 RCW AND 296.200 WAC. <br /> jo�.����.dnL,��- �/-z -o� <br /> naWre of Owner/ ontractor/ uthonzed Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />