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�NERMIT APPLICAT�iDN <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.# PERMIT i1 <br /> /�Q� P��� �suE �n �.���r-z�od�oa- � C�3o�{-03 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> ED/Ty Q�aG�,tl �`tG/ /�AU�, A oF. 9�203 �}1 S �3y�� •G6� <br /> TENANTNAME CONTACTFORPERMIT ?HONE <br /> m/KE- /hALdy ��s - k�� -��� � �<fu� <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSEII <br /> /hA�ay C'�iUST2U�%/G�) /�f�J2/ e1�ch /1�.�, /�ISdL, 1�17/ /+1AL6y�,G770q <br /> PHONE ?� �Sz, SGQ� <br /> J <br /> PROPOSED USE OF BUILDING Building f"l MeChanlCal AddiUon HEAT SOURCE <br /> v PERMIT � Combination �_� Plumbing WORN � FUIereUon � Eledric <br /> CnIST/N� TYPE Demolition LJ Sign TYPE New Gas <br /> S �. � Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK 1C �2�u � CITY OF EVERETT LOCAL SALES TAX LODE IS 1105 <br /> r_ , , <br /> WORKDESCRIPTION F-��/�Sf/ B4xca /nl P(d/` SdFF/i� � ,(�t�}2 Q� S�1/2 �P�/.<� <br /> �/aF- Tq,n�- Fx�sr.� sy�cRav� i� �pRA�" �UaT CDM,�F�. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE Of FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHINASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CI.OTHES 1NASHER METAL FIREPLACEISTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFIOW PREVENTER GAS PIPING <br /> I SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> � — <br /> I — <br /> I MEREBV CERITIFY THAT I HAVE REFD AND EXAA7INED TNIS APPLICATION AND KNOW THE SP.�14E TO BE TRUE AMO CORRECT. ALL <br /> PROVISIONS OP LAWS AND ORIDINACES GOVERNING THIS TYPE OF VJORK YALL BE COMPLIED WITM WHETHER SPECIFIED HEREIN OR <br /> NOT. TtIE C'ANTING Of A PERMIT DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE fROVISION Cf ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TME <br /> � OWNER OF THIS PROPERTY TO PERFORtd THE WORK FOR IYHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> ' CONTRACTORS LAW 18.27 RCIN AND 246.200 WAC. <br /> � ��.,D �� lL.�� APk', ��, .ZG u 3 <br /> � Signature of nedConVac r/Authonzed Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> �— <br />