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PtRMII" APPLICATI�at� �, <br /> CITY OF EVERETT PERMIT SERVICES i <br /> 3200 CEDAR STREET, EVEREl-f, WA 98201 <br /> 425-257-8510- FAX 425-257-8857 �, <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT: I, <br /> CU'JjU-1-O <br /> �p o �(oc� t�R. �ag3 ooOoaLo 3c� <br /> LEGAI LOT�O. BLOCK TRACT S�✓Ly! S.�CS �T OF (-Cr � � <br /> DESC. IR�iVC FLQ Z C�LK-09tt — O Z N�L.� OF G6! Z <br /> OWNER ADDRESS ZIP PHONE , (,�[ <br /> � <br /> Z3� RTan+ L .�('KochEso�v �Oj��o Ko��l( AG2. � VEREt'f' C�IA /�Jc ZQ .�5•1 y Fl <br /> TENANT NAM� ' CONTACT FOR AERFdIT PHONE i <br /> n� I <br /> �Y� / // //� I <br /> �� I <br /> �DNTRACTOR ' (�' I ADDRESS ZIP CONTR.LICENSE# �� <br /> ONE ���� S,Z. `'�� � -�\ � , , nU�'-��i�f m�ri'1 5�1��d\`�• <br /> � � �-l��(7�,F� .,�.� � <br /> PROPCSED USE OF BUILDING pERMIT ��rmnbi1eation R Sl9n b1�i9a1 TMPE k,( Repa i/MainL HEA�O hRCc <br /> �� �. ��\ TYPE Demolition C� .p� <br /> ICONTRACT PRICE OF WORK �V�,,��tl '--' CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I� <br /> WORK DESCRIPTION <br /> , �,�, �, P� '� <br /> p�C�« ✓v�c�n u-�uc�e� c �' /ac e� ; <br /> �I,li' 1')c-''�� h�JIRS� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM11 NO. TYPE OF FIXTURE OR ITEM <br /> WATERCLOSET(TOILE7) _ r1/C-A/HANDLINGUNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP � <br /> � SHOWER UNITHEATERS � <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHF;' RANGE HOOD <br /> LAUNDRY TRA'I WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPIACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACF <br /> FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER I _ GAS PIPING <br /> SINK(SERVICE/BAR/MOPlETC.) _ EXHAUST FAN <br /> _ OTHER �I _ OTHER <br /> — I — <br /> I <br /> �'I I HEREBY CERITIPY THAT I HAVE READ AND EXAMINED THIS APPLICATICN AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � PROVISIONS OF:AWS AND ORIDINACES GOVERNING 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 VIOLATE OR CANCEL THc PROVISION OF ANY OTHER <br /> I STATE OR LOCAL LAW REGULATING CONSTRUCTION OR'i HE PERfORA1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COh1PLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC <br /> ___'� �— =�� �—/3=c�3 <br /> ISigna ure of Owner/Contr2ctor/Authorized Agent Date i � <br /> II DEBIT & CREDIT CARDS ARE NOT ACC"!'7`:� � <br /> � <br />