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i -- - - - --- <br /> ', F �RMIT ,APPLICATIUN <br /> , CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA �8201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> � � -a-� -03 <br /> I SITE AO�RESS PARCEL TAX L�.# PE �11T x <br /> 22 Ho�fT /��C-. 0 3 �o ooz000 0�D27 ' <br /> LEGA LOT NO. BLOCK TRACT <br /> oesc. 20 21�n22 37 [ OF Ei/E�E7T AlUl,S1oN '8`' �[�. 3 (�C� <br /> OWNER ADORESS ZIP PHONE <br /> � /N�e�i�L � �o�9�u ul�1GNE� /Bu /fflv7 ,�uE QSZoi 4�s 2sa -/�v4 � <br /> I TENANT NAM� I C/n( KER P�I�C�NZ � 4 ZS �I ]� � 1(J(km(['� <br /> /r� i <br /> CONTRACTOR ADDRE55 ZIP CONTR.LICENSE# I <br /> PHONE � <br /> I <br /> PROPOSED USE OF BUILDING r�y�c Building f1 Mechanic�l I Additicn I HEAT SOURCE <br /> PERMIT � 3 Combinalion �_� Plumbing WORK Aiteration Q Electric <br /> NPE D Demolilion LJ Sign 7YPE � New �j Gas � <br /> � G�2Ac,�. u Spnnklef Repaidhlaint. U Olher � <br /> � CONTRACT PRICE OF WORK (,a' ��� CIN OP EVERETT LOCAL SALES TAX CODE IS 7105 I� <br /> WORK DESCRIPTION'JZU I LU N�.1� /��}��jE S(1ll SISJC.. I <br /> 2J C7 / � 1}u�Y 7 s2 s,F I <br /> i �I <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF fIXTURE OR ITEM � <br /> _ WATER CLOSET(TOILEI�) A/C—A/HANDLING UNITS i <br /> _ BATHTUB FORCED AIR SYSTEMS ' <br /> _ LAVATORY(WASH BASIN) HEAT PUM� �. <br /> _ SHOWER UNIT HEATERS � <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER �� <br /> DISHWASHER RANGE NOOD ' <br /> , LAUNDRY TRAY WATER HEATER <br /> � _ CLOTHES WASHER METAL FIREPLACE/STOVE �� <br /> '� URINAL FIREPLACE INSERT �. <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> i _ FLOOR DRAIN GAS RANGE �� <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOPIETC.) EXHAUST FAN � <br /> ' OTHER OTHER <br /> � . HEREBY CERIT.PV THAT I HAVE READ AND EXAh1WED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> i�ROVISIONS OF qW5 AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COI.7PLIED WITFi WHETHER SPECIFIED HEREIN OR <br /> '10T. THE GRAN i ING OF A PER1.11T DOES NOT PRESUME TO GIVE AUTHORITY 7p VIOLA i E OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULA-i ING CONSTRUCTION Oft TME PERFORMANCE OF CONSTP,UCTION. THAT I AM FU7HOftIZED BV THE <br /> C-�.:'NER OF THIS PRCPERTY TO P RFORM THE WORK FOR WHICH APPLICATION IS IdA�E AND I COMPLY WITH THE STATE <br /> '.:ONTRACT !A6V 1 7 RCb � D 9d. O l AC. <br /> � 8/� �ov3 <br /> Sigr -Owner/Contr todAuthon etl nt te '� <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />