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�- P�RMIT APPLICATIC�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETi", WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> � `� `O3 <br /> I SITE A�ORESS PARCEL TAX I.D.# PERId1T n <br /> LEGF LOTNO. ' BLOCK T ACT �1J� `/S OII�/7 .��SC�� �a i <br /> DESC. �l�is- ��S" E-U X.-`P 'G�'lS <br /> OV—/N�ER / ADDRESS 21P PHONE <br /> l /10A�a5 �C��f�el� _ �J�v1/ ffoyf }�� `���% ,�.1 � - �7`/7 <br /> TENANT NAME CONTAC7 FO'�PEiiM1T PHONE <br /> ,S:'`�.` ` %Oeu Jncfl,eil ,�T.�-- 77`/7 <br /> CONTRACTOR AO�RESS ZIP CONI'R.LICENSE# <br /> ��:-n�v <br /> PHONE <br /> PROPOSED USE OF BUILOING BUilding MBChaniCal Adtlition HEAT SOURCE <br /> PERMIi �Combinalion � Plum6ing WORK � Alteration n Electric <br /> �� � TYPE Demolition Sign TYPE Now �� Gas <br /> � Sprinkler Repair/Maint, lJ Other <br /> CONTRACT PRICE OF WORK /.J/ ��,J CITY OF F.VERETT LOCAL SALES TAX CODE IS 3105 <br /> !i <br /> IWORK DESCRIPTION � <br /> � S�� C��G�t�ic�9-�J <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FfXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET PJC-A/HANDLING UNITS <br /> I BATHTUB Z pORCED AIR SYSTEMS <br /> � J_ IAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL �- CLOTHES DRYER <br /> DISHWASHER RANGE HOOD � <br /> LAUNDRY TRAY WATER HEATER <br /> � � CLOTHES WASMER — METAL FIREPLACE/STOVE �` <br /> _ URINAL FIREPLACE INSERT � <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE � <br /> . FLOOR DRAIN GAS FANGE <br /> BACKFLOW PREVENTER � GAS PIPING <br /> �,`� SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN % � � <br /> _ OTHER_ _ = OTHER_ �/ i <br /> _ _ I — l.% <br /> i — <br /> � <br /> � I HERE9Y CERITIFV THAT I HAVE FEAD AND EXAIdINED THIS APPLICATION AN�KNOW THE SAIdE TO BE TRUE AN�CORRECT. ALL <br /> '�, PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK 6VILL BE COMPLIED WITH WHEiHER SPECIFIED HEREIN OR <br /> . �JOT. THE GRANTING OF A PERIdIT DOES NOT PRESUP.9E TO GIVE FUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER i <br /> � STATE OR LOCAL WW REGUtATING CGNSTRUCTION OR THE PERPOPMANCE OF CONSTRUCTION. TNAT I AP,1 AUTHORIZED BY THE � <br /> ' OWNEF OF THIS PHOPERTY TO PERFORM iHE'NORK FOR WHICH APPLICATION IS tdADE AND I COMPL'f WITH TNE STATE �. <br /> ICONTRACTORS LAW 1827 RCW AND 296200 WAC. I <br /> �-.-�� i�.��<._- �//�/n� �� � <br /> I SignaWre of OwneuComractonAulhonzed A�ent Date 7 ' <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED � <br />