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PERMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVIG�S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDg ESS PARCEL TAX I.D.# ��M�T� D/ � <br /> 30 ,v�4r,.1�- A�! <br /> LEGA LOTNO. BLOCK TRACT I <br /> DESC. <br /> NER ADDRESS ZIP PHONE <br /> e� � �,4�c8 �r�� � l�' Zd 3 4Z �-ZG7-�'94 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CO�CTOR � I K��.+��� ADDR:SS D 18u ZIP CONTR.UCENSE# <br /> r S��rn�J z �t ) Q <br /> PHONE ��l�'� ! / ( �Z�J � �� %IdC'aAJ�1 OO l� <br /> PROPOSED USE OF BUILUING f"') Building fi3 Mechanical fl Addition I HEAT SOURCE <br /> PERMIT �_� Combination �_� Piumbing WORK K Alleratlon Electric <br /> I TYPE �( Demolition v Sign TYPE �_( New �Gas <br /> � ��� IJ Sprinkler U9 Repair/MaInL L) Other <br /> CONTRACT PRICE OF WORK C'I � �� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> O <br /> WORK DESCRIPTION <br /> l,�(s��w GrAS F�a�P�a� lKS�2� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. . TYPE OP FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> IAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ U!JITHEATERS <br /> KITCHEN SINF:&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER __ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL � FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER Z GAS PIPING <br /> SINK(SERVICE/BARIMOPIETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> _ � — <br /> I HEREBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AN�KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIF!ED HEREIN OR <br /> NOT. THE GRAN OF A PERMIT D NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LO W REGUTATING C STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER PROPERTY T �ER R THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT RS LAW 18. A 4'�— <br /> _— _O <br /> i of Ow edConlrac odAuthorized Agent ' Date <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />