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P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STR�ET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS Z 2�B �.GRond A.�ve PARCEL TAX I.D.# P�^I7# <br /> Ev,�aef� 1.(/.4 9&20/ on s��� as9 023 00 ,,Q d3�7-�a l <br /> LEGA LOTNO. BLOCK �TRACT <br /> DESC. Z �j—Z�/ -2S S '.3 Q4`Ea»�nn� .4c�. To Evere� 2 <br /> OWNER ADDRESS ZIP PHONE <br /> �nnad�y Kondyu �Cd✓ 2218 �'. G�cind QVe, �vere�z` WA 982oI <br /> TENANTNAME I CONTACTFORPERMR PHONE <br /> 4eJ�er D�,Jner �425)3O3 '9650 <br /> CONTRACTOR Qu,�y1QIr ADDRESS ZIP CONTR.LICENSEN <br /> PHONE <br /> PROPOSED USE CF BUILDING Building Mechanical Additlon � HEAT 39URCE <br /> PERMIT B Combination R Plumbing WORK B Alteratlon D Elechic <br /> ��r,a�e TYPE Demolitlon � Sign TYPE D New U Gas <br /> B Sprinkler U RepaidMaint. U Other <br /> CONTRACT PRICE OF WORK �3�j QQ, OO CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> �u i.ec' S"�c�.� � �C's�� (`1�U� �d �06`�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FU(TURE OR ITEM N0. TYPE OP FIXT'URE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOINER _ UNIT HEATERS <br /> KITCHEN SINK 8 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 DR41N GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMItrcD THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHE'HER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRGSUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTP.UCTION. THAT I AM AUTHORIZED BY THE <br /> OW NER OF THIS PROPERTY TO PERFORM THE�VORK FOR WHICH APPLICATION IS MADE AND I COMPLY K ITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> � ;1;��/" � o� • /�i • 03 <br /> Signature of Owner ContractodAuthonzed Agent Date � <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED ` a <br />