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JUFI-13-2�-Jut 09:-!5 F��Of9:PEPPIIT 4257756315 T0: 1-ic'S'c578857 F. 1 <br /> PtRMIT APPL1ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEf�ETT, WA 98201 <br /> 425-257-8810 — FAX 42�-257-8857 � —� � -�� <br /> SITE ADDRESS PARCEL TA'X I.D.# PERb11T: <br /> 33 tit raw� �x ao �3� � � Mc�c�oc�-c3�r <br /> LEGAL LO7Np. OLOCK TRACT <br /> DESC. <br /> OWNER AODRE55 �� ZIP PHONE <br /> � o�L2. �.�f�".2 �.S 332� �-pm2r:� �'l�"2�/ �'zS-ZS"zryzS'� <br /> TENANT NAME CONTACT FOR P[RG;IT PHONE <br /> c�Q-��- iC-li1d� ; ��is 2�Tj - 8 ��7 <br /> CONTRACTOR � � ADDRE55 � ZIP CONTR.LICENSE H <br /> c�uRJ'�-I ��uZrz�r,r .�Q,njICCJ <br /> oHONE Z�UU 7����e '�+J 4y:�is� «f�sr/��=.Iy7i� <br /> 20(p L-�'L y7ll� ' � <br /> PROPOSEDU OFBUILDING Building D MbchBnical Addition HEATSOURCE <br /> �� I PERMIT � Combinalion U Pl�fnhing WORK R Altet3llon n Eleclric <br /> TVPE Demolitinn U Sipn TYPE R New Gas <br /> Sprinkler V RepalUAlaint I B Othcr <br /> CONTRACT PRICE OF WORK a �f"D, � � ��� CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> � 0 <br /> WORK DESCRIPTION � � / � I <br /> �l�l,s"(�h�� c� `T�1 �ff �L�rJ�+-;���� �'�2d �D-� <br /> _ �/crf/��,r�'� <br /> PLUMBING M1IECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM11 Nd. TYPE OF FIXTURE OR IiH�d <br /> WATCR CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB �— FORCED AIR SYSTEAIS <br /> _ IAVATORY(WASH BASIN) HEAT PU�dP <br /> SHOWER �- UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL �- CLOTHES DRYER <br /> DISHWASHER � RANGE HOOD <br /> _ LAUNDR.Y TRAY � WqTER HEATER <br /> CLOTHES WASHFR METAL FIREPLACE/STOVC- <br /> URINAL � FIREPLACE INSERT <br /> DRIDiKING FOUNTAIN —� GAS FIREPLACE <br /> FLOOR ORAIN �- GAS RANGE <br /> BACKFLOW PREVENT6R _� GAS PIPING <br /> SINK (SERVICElBAR/h10P/ETC.) � EXHAUST FAN I <br /> ^ OTHER � OTHER <br /> _ I <br /> I NEREBY CERITIFY THAT I HAVF READ AND EXAt�11NED THIS APPLICATION AND KNOW THE SAM1tE TO BE TRUE AND CORRC-Cl. AlL I <br /> PROVISIONS OF LAN'S AIJD ORIDINACES GOVERNING THIS TYPE OF WORK IVILL BE COidPLiEO lM19TH WHETHER SPECIFIED HcREIN OR <br /> NOT. TI IE G�2ANTING OF A PERAiIT DOES NOT PftESUM1tE TO GIVE AUTHORITY TO VIOLi17E OR CANCEL THE PROVISION OF ANY OTHER <br /> I STATFAR IOCAL LALV REGUTATING CONSTRUC710N OR THE PERFORM1fANCE�F CONSTRUCTION. THAT I A�.1 AUTHORRED RY THE <br /> Q1A�NER OF 7HI5 PROPcRTY TO PERFORAI THE VJORK FOR WHICH APPLICATION IS btADE AND I COMPLY l'JITH THE STia7E <br /> CONTR CTORS LA .27 RCW AND�9�.2001 <br /> �2��. v�-r�-u� C� ��/�',�d Co � <br /> Sa at re of OwnedConlradodA rized Agent ete i <br /> DEBIT & CREDIT CARDS ARE PIOT ACCEPTED <br />