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�, PERMIT APPLICATIQN ''' <br /> CITY OF EVERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREFT, EVEREl-f, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> , S -a �--� y <br /> I S;TE ADDRESS PARCEL TAX I.D.# PER"diT� , <br /> �' 3yz� �'�c1-t�� A-.�r �ov��s sz-�o�v-o� g c��tb s -oo3 <br /> I LEGAL� LOTNO. BLOCK TRACT � <br /> DEcC. � <br /> � OVlNER AD�RE55 ZIP PHONE yti ZS4-413$ �'� <br /> �I ��� I �w�.5i1/�� ���G�. 1 1`✓�Of�'IEL� �QIIL" EU(:2L'TI �+JA�'1'�20! ' <br /> ' TENANT NAME CONTACT FOR PLRh71T PHONE �� <br /> �D GiSo� YZS- Zs4- � 3�� <br /> I CONTRACTOR ��,r � f J,�,c ADORESS Z72(. /Z.�G�d2 /-L� 2IP CONTR.LICENSE# I <br /> Y � � �7 lL'/-lG�, , <br /> � 9;�zo�� t'�cir�i oe�3'�u <br /> �� <br /> � PHONE <br /> III PROPOSED USE OF BUILDING uilding f'} MEchaniCal Adtlition HEP.T SOURCE lil <br /> PERMIT Combination II--{( Plumbing wORK R AJteration D k���'� <br /> I C-��i r�'�C,,C TYPE Demolition L7 Sign NPE [SNew U�ie ' <br /> , Sprinkler �� Repair�bta�;nt. U Ot r <br /> 'I CONTRACT PRICE OF WJRK ��� S I,� 3, C�D CITY OF EVERETT LOCAL SALES'TAX CODE IS 3105 I <br /> IWORKOESCRIPTION rUN77(1ti� � '��y � [?d�Q�� �I� <br /> il <br /> I PLUMBING MECHANICAL �I <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEh1 I <br /> i <br /> �, WATER CLO�ET(TOILET) _ A/C-AlHANDLING UNITS �'i <br /> � BATHTUB FORCED AIR SYSTEMS � <br /> 'I LAVATORY (WASH BASIN) _ HEAT PUMP i <br /> � SHOWER / _ UNIT HEATERS �, / /} 'i <br /> I KITCHEN SINK 8 DISPOSA � / //�j� _ CLOTHES DRYER �� {� ', <br /> DISHWASHER y�'� _ RANGE HOOG / \ i <br /> LAUNDRY TRAY � � / 1 _ WATER HEATER �� <br /> �� CLOTHES WASHER METAL FIREPL4CE.5TOVE I <br /> URINAL FIkEPLACE INSERT �, <br /> � CRINKING FOUNTAIN GAS FIREPLACE j <br /> FLOOR DRAIN _ GAS RANGE '� <br /> BACKFLOW PREVENTER _ GNS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN � <br /> � _ OTHER_ _ OTHER <br /> i <br /> I — <br /> 1 I HERE9Y CERITIFY THAT I HAVE READ AND EXAMINED?HIS APPLICATION AND KNOW THE SA61e TO BE TRUE AND CORP.ECT ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF`vVORK'.4'ILL BE COMPLIcD'✓JITH V�'HETHER SPECIFIED HEREIN OR <br /> I NOT. THE GRANTING GF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANC�!THE PROVISION OF ANY OTHER <br /> STATE OR �OCAL�W REGUL4TING CONSTRUCTION OR THc PERFORMANCE OF CONSTFUC i ION. TH4T I AM AUTHORIZED BY THE <br /> O',NNER OF THIS PROPERTY TO PERFORM THE WORK FOR�VHICH r�PPLICATION IS h1ADE AND I COM1iPLY LVITH THE STATE � <br /> �ONTRACTO W 7 RC6V ND 296.200 WAC. <br /> ��� 5 'y/ay <br /> ��r,nat re of wnedContractorlAuthonzed Agent Date <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED ___�_ <br />