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� i� <br /> PERMIT APPLICATION <br /> ClTY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 � `�-I ` b y <br /> 425-257-8810- FAX 425-257-8857 / <br /> �U� 4�bS - �� <br /> , <br /> SITE ADDRE55 PARCEL TAX I.D.# PE 7# , <br /> � ' <br /> 3Cn5 I._I7nn8r1 `< 1� DD a390763 oL�' !��- �5 - �>c'-� <br /> LEGAL LOTNO. BLOCK TRACT ._�� <br /> oesc. " //� ; SG FIRST f� DUITIUN <br /> OWNER ADDRESS ZIP PHONE <br /> i 1 �i1N1 i L !_�i FI �7 f-< � �'. 15 LDMBARD� 3✓�%J1 47S-Z50 -71ZS <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> N �: f�IC !',� I� IIAEL CRO55 h �5- 334 - I�f3 <br /> CONTRACTOR ADDRESS ZIP CUMTR.IJCENSE# <br /> ( +VfIAIL 't _`. <br /> PHONF <br /> PROPOSED USE OF BLIILDING �uilding n Mechanical Addition IIEAT SOURCE <br /> 1,1�( .f ""� � (��� (� T"t f)O(�f� PERMIT Combinalion F� Plumbing WORK Alleralion ��-((Electric <br /> � TYPE Demolilion LJ Sign TYPE /New �{ Gas <br /> Sprinkler RepairlMaint. U Other <br /> CONTRACT PRIi.E OF WORK �J (j (/%;(7 CfTY OF EVEREff LOCAL SALES TA7(CODE IS 7105 <br /> � <br /> WORK DESCRIPTION <br /> I�( I ��Inl !J '�n-) !_ (-�� XISTINIr [1 /\ RAIr !=- IC� P U ':!�_ A� A <br /> `�,, �� t_ -! I f�,J L ir_ U r1 M <br /> '��L( '��- Oo�� <br /> PLUMBING MECHANIC/�L <br /> NO. TYPE OF FI%TURE OR REM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCFIEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHFR RANGE HOOD <br /> LAUNDRV TRAY WATER HEATER <br /> CLOTHES UlASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> __ — � <br /> I HEREbY CERITIFY THAT I HAVE READ AND EXAMWED THIS APPLICATION AND KNOW THE SAMe TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINAf,ES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPEi.IFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DCES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORtdANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> ' OWNER OF TNIS PROPERN TO PERFORM TNE WORK FOR WN{CH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> COIJTRACTORS LAW 1827 RCW AND 29G200 WAC. <br /> ��UL(�t:�QW� �/.,C ��/�✓L` f(( LC�� G'� 1--�x-� �- <br /> Signalure of OwnedContractodAuthorized Agent Date �/nl <br /> C <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />