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I� cRMIT APPLICATI�IN <br /> CITY OF EVERETT PERMIT SERV�CES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.M PERMIT s <br /> Z2 ! 1 �1 � cie . � Pc�3dZ-ol3 <br /> LEGA LOTNO. BLOCK TqACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> � �ore � cP �.�1 ��Sv� 2111 JAc� . �C �c�e't�' �'�5021 ��I25• 254- �251 <br /> TENANT NAME I CONTACT NAME pHONE <br /> CONTRACTOR ADDRESS � 21P CQ147R.LICENSE R <br /> �.., G. .J4h�.;he� s � e0 (,�veo�. P..ne A�e . N �ZS� ��51 �� — � ��� ��cou q <br /> n (� /� ..�r��__..r_.. r�j. <br /> PHONE SCcif'I� � �.(1l'f -l`dIO-1 ZO�pZtJD7�lG� � <br /> PROPOSED USE OF BUILDING I B�illding (� MEChanlCal Adtlilion HEAT SOURCE <br /> PERMIT � Combination K ?lumbing WORK Alieration Eledric <br /> 7vPE Demolition V Sign TYpE tJew R�-( Gas <br /> Sprinkler Repair/Maint. V Other <br /> CONTRACT PRICE OF WORK �Z ��n�,�� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIFiION � \ i`" i^h I � Il a � ;U" <br /> Vti,_; „Li t([iAl <br /> PLUMBING MECHANICAI_ <br /> NO. TYPE Of FIXTURE OR ITEM N0. 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 _ UNITHEATEFS <br /> KITCHEN SINf(& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> C�OTHES WASHER MEiAL FIREPLACE/5TOVE <br /> URINA� FIREPLACE INSERT <br /> DRINKING FO�NTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> � BACKFLOW PREVENTER GAS PIPING <br /> _ SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WOfiK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTINC�OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIIY TO VIGLATE OR CANCEL THE P90VISION OF ANY OTIIER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I Atd AUTHORIZED 0Y THE <br /> OWNEFi OF PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> C TRACTO S W tB.27 RCW AND 296200 WAC. <br /> `.�/,,,V, � 2 - 1�- �3 <br /> Signature of Own UCo tractodAuthorized Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />