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RPR-19-20D6 09:35 FR011:PERIIIT 4257756315 T0:14252576857 P. 1 <br /> { ( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- �AX 425-257-(3857 <br /> SITE ADDRESS PARCEL TAX I.D.ii PERMIT� <br /> -�"j p �4rlC'V/P.4� � O S3CL�Z5dc� IN1o(oc�f-c� <br /> IEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OVdNER ADDRESS 21p PHONE Z <br /> _�U-e -�,�2u �1�2.a��C�!"J � �S�/OS l�a �Kl//��t 9�'Zo3 3 �(7Z�`/ � <br /> TENANT Nqh1E CONTACT FOR PERMI7 PIiONE <br /> c��2i2�e� I ,(a�1d�L yzr 2-7�- � '-t5� <br /> CONTRACTOR � � ADDRESS ZIP CONTR.LICENSE# <br /> c,uF}s�-I �jw-��r� �.rtrlUJ <br /> PHONE � ���G� �H rC �CJ C��cI��ILG'.I`97I� <br /> zol� �L y-7�r� a � �� `���9 <br /> PROPOSED USE OF BUILDING Buildfng f5��qeChaniCal Addillon HEAT SOURCE <br /> � PERMIT R COmbin8li0n F h�lumbinp WORK �Alteralion I �Electric <br /> �—�� TYPB g Demolition L� Slc�n TVPE Now Ges <br /> Sprinkler RepaldMaint. Ofher <br /> CONTRACT PRICE OF WORK �D� — CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION � �� � � <br /> �({1s�a.//i � � 9.�1 �rl�Qce � <br /> ��� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEtd NO. TYPE OF FIXTURE OR ITEh7 <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 /> _ KI7;HEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY WAl'ER HEA1 ER <br /> � _ CLOTHES WASHER '— A4ETA�FIREPLACE/STOVE <br /> i _ UR�NAL FIREPIACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RF�NGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK (SERVICE/BARIMOP/ETC.) EXHAUST FAN <br /> _ OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXA�dINED THIS APPLICATION AND KNOW THE SAA1E TO BE TRUE AND CORRECT. AlL <br /> Pi20VISIONS OF LAWS AND ORIDINACES GOVER;JING THIS TYPE OF INORK�VILL BE CO�r7PLiED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THc GRAN7ING OF A PER\11T OOES NOT PRESVAI[TO GIVE AUTHORITY TO VIOW7E OR CANCEL THE PROVISION OF ANY OTHER <br /> S7ATE OR LOCAL LAW REGUWTING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2E0 8Y THE <br /> OWNER OF THiS PROPERTY TO PERFUHM IME WORN FOR WHICH APPUCA?ION IS MADE AND I COMPLY WITH THE STATE <br /> CONTR CTORS l,q , .27 RCW AND 290.2�0�. , !/� <br /> �t� �Uf� <br /> ����. �c__�� , <br /> Si at re of Ovrner/ContractodA nzed A�ant Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />