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t l <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> - q�l q�Q� <br /> SITE ADDRl9E pARCEL TAX I.D.# PERMi7 p <br /> a ew,� N e. I l'►'�(�vq- � 3 <br /> LEGA� L07 NO. �LOCK TRACT '� <br /> DESC. <br /> WNER ADD S 21P <br /> —►���P� � PS S�aCrz ac,�'^ p��� �rr.�iCe Re�c�'� x�x.o� �fas-�7 <br /> TEN/WT NAME I CON7ACT FOR PfiRMIT PHONE <br /> S�nacv-�pY1�C��� Z53 QSl��.� _ <br /> CONTRACTOR��p��a �� `(k, ApDRESS �j�0� D r N� Z�P CONTR. ENS <br /> Hu.bum,wR asoc� em�e`�►�o�s'�x., <br /> PHONE ar��aj S�I2 S(e(oS <br /> PROFOSEO USE OF BUILOING I BUlld'Ine Mechanical Additlon HEAT SOURCE <br /> PfiRM1T B Combinalion Plumbing WORK AlMration �1 Eleclrie <br /> tvP& U pemolftion �Sign ME � New I u 6as <br /> U Sprinkler RepairlMalnt LJ Other <br /> CONTRACT PRICE OF WORK � bOO G� CITY OF EVERETT LOCAL sALES TAX CODE IS�105 <br /> WORKDESCRIPTION �� g y��s{�n� '�.5.,�.� P�� w $. n�� ��� <br /> CX�n-c�� o��- W�-7. bOr �S..�GR . SG�fvk'• W2�� <br /> PLUMBING MEC ANICAL <br /> N0. TPE OF FI%TI1RE OR ITEM NO.. 7YPE OF Fp(TURE OR ITEM <br /> _ WATER CLOSET(TOILEn „ A/C-A/HANDLING UNITS <br /> _ BATHTUB FORC@D AIR SYSTEMS <br /> � LAVATORY(WASH BqSIN) �- HEAT pUMP <br /> _ SHOWER UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL � CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY WATER FIEATER <br /> _ CLOTHES WASNER METAL FIREPLACE/STOVE <br /> ^ URINAL , FIREPIACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN � GAS RANGE <br /> _ BACKFLOW PREVENTER � GAS PipING <br /> i SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER , OTHER <br /> 1 HEREBY CcRITIFY THAT I HAVE REAO qND EXAAIINED THIS rPF_�'ATION AND KNOW THE SAME TO BE TRUE AND CORRECT. A�L <br /> PROVISIONS OF I,AWS AN�ORIDINACES GOVERNING THIS 1YPE C�WORK Wlll BE COMPLIfiD WITH WHET��ER SPECIFIED MEREiN OR <br /> NOT, iMc GR4N71NG OF A PERMIT DOES N07 PRESUME'O GIVE AUTHORITY TO VIOLA7E OR CANCEL TF1E PROVISIQN OF ANY OTHER <br /> STATE OR LOCAL L4W REGUL4TING CONSTRUCTION OR THc PERFORMANCE OF CONSTRUCTION. TMAT i AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO P=RFORM TME WORK KOR WHICFI qppLICATION IS MADE AN�I COMPLY W ITH THE STATE <br /> CON7 'ACTORS LAW 1827 RCW AND 296.200 WAC. <br /> I <br /> � � � <br /> i re- d ow�e ractoVAuthonzetl Agent ate <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> � 2d 14d0Z:ZT 900Z 6S 'daS L6LSZL8£SZ : 'ON Xtl� 'JNI 3alti Q�tia3lJ3 : WO'J� <br />