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- - _ _ _. _- <br /> --- - . ------ —1 <br /> PERMIT APPLICATION ��i <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.# P M�T� <br /> � \'� ' h �T 'Jr b z 3 � �c� 4�C0 C��`f�3�o <br /> L[GAL LOT NO. BLOCK TRACT ' LC�T T� • � <br /> oesc. -- ---�--�`ij _��,n-r �v Fti� oF ��� �Z DoC -•Si <br /> OWNER ADDRESS ICIQkLA�.17 Z�P PHONE �N ` '` 10 <br /> �CG-' �-f �'�1���� �GG22 N� \'��zir�b`�'T # � q�t�'3�� N�fi-�S199$—� <br /> TENANT N`JE I C�G��OR PERMIT�\1'� � PHONE <br /> =� C G � ��S " 2U� ' I �1°�� <br /> 'CONTRACTOR ' �V N ADDRESS ZIP. CONTR.LICENSE g <br /> Sva,> �`I.� W r1��T 1v L� j OC�D �Lt,�o�� (�n o a>N L_12 <br /> PHONE � �.�� '. � 7O ' � �L� SI�I',�LM�S1�1 W,I{ ��G��G <br /> PROPOSEO USE OF BUILDING 1�7(Building Mechanical Addition HEAT SOURCE <br /> INGLv FA���LY PERMIT H Combinalion R P!umbing WORK �Alteration I �Electric <br /> S I TYPE �j Demolition D Sign TYPE Nmv Gas <br /> �s����� u Spfinkler RepaidM1lainl Olher <br /> i CONTRACT PRICE OF WORK } nOG JC> CITY OF EVERETT LOCAL SALES TAX CODE IS 5105 <br /> _1 <br /> ��I WORKDESCRIPTION' fl�IliL�INL' � N�� S I�I1�'W�-'�'` - N��1 St����T�'�K <br /> {� I <br /> . w,A�,N� �, W ,o�,2 ��, r oQb'�IW1r _ hiN�SNir�i� Fut�s <br /> I <br /> - ��'Ov���lr f� 1X�%�2 I <br /> ; PLUMBING MECHANICAL <br /> ' NO. TYPE OF FIXTUkE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> � WATER ClOSET _ . NC-NHnNDLING UNITS <br /> � BATHTUB _ FORCED AIR SYSTEMS <br /> i LAVATORY(WASH E3ASIN) ..__ HEAT PUMP <br /> i SHOWER _ UNIT HE�TERS <br /> ' - KITCHEN SINK&DISPOSAL __ CLOTHES DRYER <br /> ' DISHWASHER .___ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> I � CLOTHES WASHER _ 64ETAL FIREPLACE/STOVE <br /> � URINAL _ FIREPLnCE INSERT <br /> '� DRINKING FOUNTAIN ____ Gl1S FIREPLACE I <br /> 'i FLOOR DRAIN __ GAS RANGE � <br /> ' BACKFLOW PREVENTER __ GAS PIPING <br /> ' SINK(SERVICEIBARIMOP/ETC.1 _ EXHAUST FAN I <br /> � OTHER OTHER_ _ � <br /> -- --_----- — —. _— I,� <br /> I HEREBV C[RITIFY THAT I HAVE READ AND EXAMINED THIS APPLICA?ION AND KNOW THE SA1+IE 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. THF GR�NTING OF A PERMIT DOFS NOT PRESUAfE TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAI LAW REGULATING CONSTRUC�ION OR THE PERFORhIANCE OF CONSTRUCTION. THAT I AA1 AUTHOR12ED BY THE <br /> � OWNER OF THIS PROPERTV TO P[RFORM THE WORK FOR WHICH APPUCATION IS h1ADE AND I CO�dPLY WITH THE STATE <br /> �, CONTRACTORS LAW 18 27 RCW AND 296200 WAC. � <br /> � .� � �L ti �L'C �-�� <br /> i��,.� �'�� q�'�_ <br /> ' SignaWre of Owner/C ntractod�ulLorized Agent Date , <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED /� <br />