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�ER;MIT APPLICAT�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N PERMiT� <br /> E C��.�uv A�I,F� i'Yl 3 / 1 -bo�o <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 ZIP PHONE <br /> '�tZ�sT1 �Asl-1 � ����'Le_� G'1 �u��01 l`C�-5� �O3-U� p <br /> TENANTNAME I CONTACTFORPERM�T PHONE <br /> _�— <br /> CONTRACTOR �`� '�5,������ApDRESS 1 1 l � ����� �� ZfP CONiR.UCENSE/ <br /> PHONE C�.il/e_1U 1 � WA lV ZD` �A�I�.S � ���N <br /> (425� z5G -�+�a� <br /> PROPOSED USE OF BUILOING Building � Mechanical Additlon HEATSOURCE <br /> "� PERMIT Combination Plumbing WORK Atteration yn�Eledric <br /> 1` IYPE Demolition Sign IYPE New /�Gas <br /> �\eS� cl en-h�„` Sprinkle� RepafdMaint. V Other <br /> CONTRACT PRICE OF WORK � C �� cl �� CITY OF EVERETf LOG�L SALES TAX CODE IS 3705 <br /> J Ot <br /> WORK DESCRIPTION <br /> - � 11S•�z-.�.�` �`e�-- S-�-Gnc�i.�5 C�C.s S�ve w ;-�-1-� V�r�'� � cJGzs (� �o I�.�ol p <br /> - � t'�s-�r..�.� C-�'CS ��!'e�`GCA 1C1� �v�^cCT boX � �O�L V�f' � <br /> � C.f� � i .�o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. . iYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A1C—A,'HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> C�OTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKINGFOUNTAIN � GASFIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BARIMOP/ETC.) EXHAUST'rAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I Hl.VE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND JRIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TFiE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGU WTING CONSTRUCTION OR THE PERFORh".ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND�COMPLY WITH THE STATE <br /> CON RACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> �t,w�t i�l. �-,, h 111�y lv� <br />, Sign ture of OwnedContractor Authonzed Agent Date I <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />