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( — <br /> PERMIT APPLICATION <br /> CITY OF EVEkETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8Et10—FAX 425-257-885'7 <br /> SITE ADDRESS PARCEL TAX I.D.M �ERMIT• <br /> �72QS OI w�y�;� DZ . CK�03 � loc9oo�o0 ' �� - D:� <br /> LEGAL LOTNO. BLOCK TRACT � <br /> DESC. � 3�ve��q N ,1\7 >,,, 1 <br /> OWNER ADDRESS aP PHONE <br /> S I� L L�C 72oS Oi �� ,..., �,; � ��: �t8zo3 Nts -��o �s9s8 <br /> � �, �, � <br /> '�'ENANT NAME CONTACT FOR PERMIT PHONE <br /> Sc_„�„e qS Ok��.tN:' <br /> CONTRACTOR c Ir ADDRESS 7JP CONTR.IJCENSE� <br /> .�t � 5�.....< <br /> PHONE <br /> PROPOSED USE OF BUILDING BP Iding � Mechanical ( AdPition I HEAT 90URCE <br /> PENMIT B Combination Plumbing WORK �Alleretion D Eiearic <br /> TYPE D Demolition Sign TYPE New D Gas <br /> U S rinkler Re airMlaint. U Olher <br /> CONTRACT PRICE OF WORK ,t� �Z,� p0 p `-S— CITY OF EVERETT LOCAL SALES TAI(CODE 131105 <br /> WORK DESCRIPTION <br /> �1c(d �{ �c�. Tc �: �lcl.,�• ��, iYI � <br /> /� X � I�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET /VC-AIHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> = KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> � DISHWASHER _L RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINK�NG FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICEIBAR/MOP/ETC.) EXHAUST 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 VJORK WILlBE COMPLIED WITH NMETHER SPECIFIED HEREIN OR <br /> NOT. THE(>RANTING OF A PERMIi OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE O LOC;AL LAW REGULAjING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TNAT I AM AUTHORIZED BY THE <br /> OWNER�F(7HI5 PROPERTY Tp P FORM THE WORK FOR WHICH APPLICAT ON�5 MADE AND I CUMPLY WITH T 1E STATE <br /> CONT C70RS LA 1827 RL`W , D,Q9('i200 WAC. <br /> / �� � <br /> � � ��. -� �/ �� <br /> 5 n ure ot wnerlCoqt ctor/Author¢ed Agent ` ate <br /> I� <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />