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PtRN!!T APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8G57 <br /> I <br /> ��vvv 6r,otio Av� - <br /> SITE AODBESS � PARi3EL TAX I.D.# PERMiT a <br /> '� ip� �AwIL Q-r ZZN' pD '-1 US-olS <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS 21P PHONE <br /> �vE�cc,r �ra���s ��-aT . <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Si'Nru� wt�5 �Srtiucr�ur., �.�-v�� Sr��c.nt�e�.� '3(sd-�41 -��c�4— <br /> CONTRACTOR ADDRE55 ZIP CONTR.LICENSf_1! <br /> PHONE 7jCPG - Z��i -'�I.� �j Ce <br /> PROPOSED USE OF BUILDING Building fl Mecnanic2l Addition HEAT SOURCE <br /> PERMIT B Combination ��� Plumbing WORK � Alleratlon � ElecVic <br /> TYPE D Demolition lJ Sign TYPE New Gas <br /> U Sprinkler Repair/MainL � Other <br /> CONTRACT PRICE OF WORK �2 S� / CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> � <br /> WORK DESCRIPTION � <br /> -f�� Crn 1A U.�O�u) 2�` ��� V//11'E�L � /L�2 �� ��A2([ S ��r. <br /> y... �. . � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILC�T) _ A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> i = DRINKING FOUNTAIN = GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> L�ACKFLOW PREVEP:i ER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER �Di K�__ ��� _ OTHER <br /> I — — I <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINE�THIS APPUC.�TION AND KN04V THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF N'ORK WILL BE COMPLIED N'ITH WHETHER SPEGFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTh�RITY TO VIOLATE OR CANCEL Th'�PROVISION OF ANY OTHER I <br /> STATE OR LOCAL W REGULATING CONSTRUCTION OR THE PERFORMANCE Of CONSTRUCTION. THAT I AM AUTHORIZED BY THE � <br /> OWNE THIS ROPERTY TO PERFORAI THE WORK FOR WHICH APPLICATION tS A1ADE AND I COMPLY WITH TNE STATE <br /> CON �AC ORS N 18.27 RCW AND 296200 WAC. <br /> --, �J �'/ �' <br /> Signatur 91 OwnedContrac odAuthorized Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />