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��e <br /> . � <br /> , <br /> PytRMiT APPLBC�\TION <br /> CITY OF EVERETT PERMITi SERVlCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS ' / n PARCEL TAX I.D.# PERi�1!T� <br /> Z ��v��� f��e., 005�1�1� oo� oo ► o� Ca3o�-cx��{ <br /> LEGAL LOTNU. BLOCK TRq, T. <br /> DESC. � S I� � I2O�' � I� � � <br /> OWNER ADDRESS ZIP PHONE <br /> Hr��c�� ��os, c���-r ��aa 57��� ti� �82Qs yZ5-397 -7360 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � Sd�l �o,nc�� Lj25 z�o-�WZ� <br /> CONTRAC�TOR ADDRE ZIP CONTR.LICENSE# <br /> �-�A(�C1� $��cF. corJST. 39a�, 87��� �Vt� �ut�ET7' �2�r �}�HC�t1310�LJ'�Z <br /> PHONE <br /> i`125- 3`l �` �360 <br /> NROPOSED USE OF BUILOING Building D Mechanical I Addition HEAT SOURCE <br /> �� Q PERMIT � Combinalion U Pl9mbing WORK R AlteraUon I � Electnc <br /> �` TYPE Demolition U Si n 7YpE New Gas <br /> Sprinkler Repalr/Maint. Other <br /> CONTRACT PRICE OF WORK g�'O�Q //�/0/ CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> N �� SF � <br /> PLUMBING !NECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO.. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) � A/C—AlHANDLING UNITS <br /> � BATHTUB � FOkCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) : HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> � DISHWASHER Z RANGE HOOD <br /> ! L4UNDRY TRAY L WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN = GAS rIREPLACE <br /> FLOOR DRAIN I GAS RANCE <br /> BACKFLOW PREVENTER � GAS PIPIt�G <br /> _ SINK(SERVICE/BAR/MOP/ETC.) L/ EXHAUST FAN i <br /> OTHER T OTHER <br /> — — — 1/ <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PftOVISIONS OF LAWS AND ORIUINACES GOVERNING THIS TYPE OF WORK WILL OE COMPLIcD WITH WHETHER 5PECIF�ED HEREIN OR <br /> NOT. THE GRANTING OF A PER�AIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE O CAL LAW REGULATING CONSTRUCTION OR THE PERFORMFNCE OF CONSTRUCTION. THnT i nM AUTHORiZED BY THE <br /> � NER O T PROP RTY TO P F M THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> O C RS 1 . RCW A 6.200 WAC. <br /> Signatu of Owner/ ont C r uthoriz d Agent � �Date <br /> / <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED L I <br /> � <br />