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P�RMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 2Z 1��+2k i�LJ,}c,� 00 (�0(�l0000yq0l C. 30�- ��/ <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. U) ��� � <br /> OWNER ADDRESS • ZIP PHONE �O3`ZS3 <br /> ��duL. � 1..4w�.�4- (/�4N S<<, f�-- yZz ��.k ►� . �1$z03 <br /> TENANT NAME CO TACT FOR PERMIT �Q � PHONE "� <br /> `A� u,aN s� _-° �3 a� �� <br /> CONTRACTOR � ADDRESS ZIP CONTR.LICENSE# <br /> �^' �rz—�vati scyc� �ssa�. '/�t� ( <br /> PHONE q"I U ��1 I 2' YiTN 1�. .9-r o Z/D <br /> (J <br /> PROPOSEDUSEOFBUILDING SF �uilding n Mechanical 'RTAddition � HEATSOURCE <br /> ��Z,9,G� • PERMIT Combinalion �_� Plumbing WORK �K Alleration � -�'-�«�c <br /> 'Q1 , p TYPE emolition LJ Slgn TYPE �( New � . �..;., <br /> {y�ty `� UE.,(�pdq. Sprinkler U Repair/MainL ._ �hc� <br /> CONTRACT PRICE OF WORK CITY OF BVEREIT LOCAL SALES TAX CODE IS 7105 <br /> WORKDESCRIPTION /�,� 4� }; � �,� <br /> ADDir� nrJ - G E-. �x��an� �h�OM . <br /> PLUMBING MECHANICAL <br /> NO, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM� <br /> / WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> —T BATHTUB FORCED AIR SYSTEMS <br /> �� LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER R.4NGE HOOD <br /> LAUNDRY fRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE�NSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETCJ �� EXHAUSl FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT 1 HAVE READ AND EXAMINED 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 WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORA7 THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 10.27 RCW AND 296.200 WAC. <br /> 5�.'o/d� <br /> Signalure of OwnedContractor/Aulhonzed Ac�ent �at'e <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED ��� <br /> � 1 <br />