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� P�RMIT .APPLICATIG�J <br /> CITY OF EVEREZT PERMIT SERVICES <br /> 3200 CEDNR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> 5-I� -o L� <br /> Sll"E ADDRESS PARCEL TAX I.D.# P Mi7» ��� <br /> jo ! a�r�� sT sv«-�"T Y"�a�� u 3�. o�ci 000c�o ��/°�� � 1 <br /> LEGAL LOTNO. BLOCK TRACT I <br /> DESC. I <br /> OWNER ADDRESS ZIP PHONE <br /> rac��le7 NE«5,;,�, ti����Yr r' ��� rol6 u� ��: ��7 y�a�i yas-a.�g-s�a� � <br /> TENANT NAME CONTACT FO PERtAIT PHONE <br /> i <br /> G� lp�� �(cc�i� ,��G- '��9- 3�-S % ' <br /> CONTRACTOR /3���i� ADORESS }�a( �,�Ud�G/✓ Z�P CONTR.LICENSE# �' <br /> /'z-L/�Ivr ,y- 13E�1o�G9y�r,J <br /> rHONe ,�pG -� 3 d-G 6c7C� Sea nIe 9�/c� <br /> PROPOSED USE OF BUILDING � BUilding f� MechaniCal ( � Addilirn HEAT SOURCE I <br /> PERMIT Combination Fq Plwnbin3 IWORK Alteration Eizclric i <br /> TYpE Demolition L/ Sign TYPE New Gas I <br /> Sprinkler RepairlMaint. Ofher <br /> — I <br /> CONTRACT PRICE OF WORK /G �,��(�� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION � / � / <br /> /(�{��iuL4+,?.t✓ a LtTL�'� �C/'.,c.rlt� Nr�f.li�.CGu- C./_L�'�� ?,C�r.ct i'.�.�,(i'.��:i//C� 4,-F.c.�.r//"-" <br /> '� �� � �'' f � � ��-C/ i <br /> ,C�u�f.� �Guc�(� .G c'r�-'•�" S� �C���! .�n arc�y�rl� .,ct Gwi. rs <br /> I <br /> � <br /> FLUMBING MECHANICAL I <br /> N0. TYPE JF FIXTI�RE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATE�CLOSET(TGILET) _ A/C–AIHANDLING UNITS <br /> / BP.THTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> � SHOWER � UNITHEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> li _ DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WAShiER METAL FIREPLACE/STOVE I <br /> I URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE I <br /> FLOOR DRAIN _ GAS RANGE I <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICEfBARlMOP/ETC.) _ EXHAUST FAN <br /> ` OTHER OTHER <br /> I I �1EREBY CERITIFY THAT I HAVE READ AND EXA611NED THIS APPLICATION AND KNOIM1'THE SAh7E TO BE TRUE AND CORRECT. ALL II <br /> i PROVI310NS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF 6VORKlVILL BF COM11PLIcD WITH�NHETHER S°ECIFIED HEREIN OR � <br /> ' NOT. THE GRAUTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHOP,IN TO VIOWTE OR CANCEL THE'PROVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGULATWG CONSTRUCTION OR THE PERPORP.IANCE OF CONSTRUCTiON. THAT I Atd AUTHORIZED BY THE � <br /> �. OWNER OF THIS PROPERTY TO PERFORM THe WORK FORVJHICH APPLICATION IS MADE AND I COMPLY WiTH THE STATE ��. <br /> �� CONTRqCTOR$LAW i827 RCyV AND 296.200 WAC. 'I <br /> ��.c,� ,�-o-� � /- v� � <br /> ISignaiwe of Owner/Contrector/Author ed Agent Date i <br /> ' , EBIT & CREDIT CARDS ARE NOT ACCEPTED ' <br />