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- , * i <br /> '� P�RMIT APPLICATIVN � <br /> AfF��v�eb $s� CITY OF EVERETT PERMIT SERVICES <br /> q�j_- DO� 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810- FAX 425-257-8857 <br /> i <br /> SITE ADDRESS PARCEL TAX I.D.# I PEFjMIT.� ! <br /> � - Z. G[ di� J�r ,uE oc,�t 2 7�( or�G�-,r. 'LoG � rL l.f D(� -OC�� j <br /> LEGA LOTNO. BLOCK TRACT � <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> ,�,�''�tN� agoNl�iaRT ��l?� l�. M�F���JD.��� 1�, �D�anc tJa. yas-�i3 63 S <br /> TENANTNAME (� )/ CONTACTFOR ERMIT —� PHONE I <br /> IjE�S �l�-L�j iGr ,t:aJ�---� �bL3 LIr►RISTBNSE/V �161{ �.l$ tgZ1 <br /> F "�_ <br /> ' ��ac ;o� �'G- � ' <br /> CONTRACTOR ADDRESS � ZIP CONTR.LICENSE# <br /> PHONE -��'�\ <br /> PROPOSED USE OF BUILDING Building f� Mcchanical Addilion HEAT SOURCE <br /> PERMIT Combinalion r-� Plumbing WORK Alteretion �n-(�Electric <br /> 'j - 4tN �T !u�yO,�t���Ui .n,pE Demolition LJ Sign TYPE New ,�Q Gas <br /> Sprinkler Repair/Maint. U Other <br /> CONTRACT PRICE OF WORK �G�S/jsr) — CITY OF EVERETT LOCAL SALES TAX COUE IS J705 I <br /> .� :���.�.. <br /> WORK DESCRIPTION <br /> LCNS1iLNG11UrJ �.r r��� •.3- u�o�T ��av�,•.� a� K�� i <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C-A/HANDLING UNITS I <br /> BATHTUB FQRCED AIR SYSTEMS <br /> AVATORY(WASH BASIN) HEAT PUMP <br /> S OWER IT HEATERS <br /> KIT EN SINK& DISPOSAL . CL THES DRYER <br /> DISH SHER / RAN HOOD <br /> _ Lr1UND TRAY WATER ATER I <br /> _ CLOTHES SHER METALFI PLA STOVE I <br /> URINAL FIREPLACE I RT <br /> DRINKING FOU IN GAS FIREP C <br /> FLOOR DRAIN � GAS RA E I <br /> BACKFLOW REVENTER GAS P ING <br /> SINK(SE ICEiBARIMOPIETC.) E U.riT FAN <br /> OTHER HER <br /> I <br /> � — — — � <br /> —I i <br /> � I HEREBY CERITIFY?HAT I HAVE READ AND E V+M1llNED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL I <br /> PROVISIONS OF WWS AND ORIDINACES GOVERNING THIS Tl'PE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIEG HEREIN OR i <br /> MOT. THE GRANTING CF A PERAIIT DOES NOT PRESUA4E TO GIVE AUTHORITY TO VICLATE OR CANCEL THE PROVISION OF ANY OTNER 'i <br /> STATE OR LCCAL LFW REGUWTING CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TriE I <br /> ' OWNER OF THIS PROPERTY TO PERFOR�d THE WORK FOR WHICH APPLICATION IS tdADE AND I COMPLY WI7H THE STATE '�� <br /> CONTRACTORS LAW �8.27 P.CN AND 296.200 YVAC. i <br /> / � i <br /> � l <br /> �i�..,�;�(�' ., �,-%'/'�i� . ��3/�f �3 , <br /> ., ignature of OwnenContra� r/Aut ion<-ed Agent Date �, <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED ' <br />