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P�rtMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR ;iTREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT# <br /> �ti� o�K� v� . Uo�r�sy��9 ov�o- l� �7- ��l <br /> LEGAL LOTNO. BLOCK TRACT <br /> ('� ..> �J�.�•��i <br /> DESC. 25 Pp^n1L7•�) ��' HIC.�J✓I L A�7 !—� <br /> OWNER ADDRESS 21P PHONE <br /> I�i:i.�-� � �uL� e �a,y��Y,�S? �/4�ZJ1 �(Z`� 25Z Gl� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> dl�.�e_ G�Av, >> /��nr�;,��. `/zS S�� �-I>S'� <br /> CONTRACTOR (��� � ` �:A�R��` ADDRESS 21P CONTR.LICENSE N <br /> � n /� /� <br /> PHONE � � _ ���, r �7�,�:!C�'C�«1� 1�JQ. 7�J' �:�1 j�ACIrG1J��l.� <br /> '��� c.� 1 � i l <br /> PROPOSED USE OF BUILDING r�nt-Building Mechanical Addition HEAT SOURCE <br /> I�e T c�-c �'� ��� PERMIT �� ) Combination � Plumbing WORK �Alteration n Electric <br /> TYPE D Demolilion U Sign IYPE New �� D Gas <br /> Cna �� � �e_ <br /> �� Sprinkler Repair/Maint. D Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> WORK DESCRIPTION � <br /> n��,� � �,� >> G-A�-� �-�_ ��L�.�� � , T �_�, � �-,�,.�,_ : s�-� � <br /> ",n.�C.` �:JJ � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM r� �� NO. TYPE OF FIXTURE OR ITEM <br /> N/� <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 /> DISH�VASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE REA�AN�EXAA1INED THIS APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LA'N REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPC-RTY TO PERFORh1 THE WORK FOR WHICH APPLICATICN IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS lAW 1B.27 RCW AND 296.200 WAC. <br /> '�� .� /�. �� - ,� / 7'�J .��j ///'''��� <br /> Signature of O�medConlracror/Authorized Agent Dale � <br /> Z <br /> DEBI? & CREDIT CARDS ARE NOT ACCEPTED <br />