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PE.�MIT APPLICATIO� � <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.k PERMIT u <br /> Z�/ 03 �4c ;�c� vL ZSa�/3oo loY 90 � �' b <br /> LEGA LOT NO. BLOCK TPACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> ���vlt o� /4M er.. 5 �•o. l;�K g�/o 750 /�9//�t 3 � �'K 75� 2 FS� <br /> TENANTNAME CONTACTNAME PHONE <br /> pGNN � S�CV L ��0� � Y25' 7�� � p d 35 <br /> CONTRACTO �Lrr Ntun.i [ o ADDRESS ZIp CONTR.LICENSEM <br /> PHONE r 7�fOo /��v��sv.v �� �jr_rryNto77ch. <br /> ts'- Evc�cF(, w{ 4fi'26 3 � <br /> `/ 77G- �83s- <br /> PROPOSED USE OF BUIL�ING Building 17 Mechanicai Addition � HEAT SOURCE <br /> R PERMIT R Com6inalion �-� PI�um6ing WORK�Iteretion � Electric <br /> �y�r y,,.,�T TYPE Demolition �� n IYPE ew Gas <br /> B Sprinkler(x ol heetls) Repair/Maint. Other <br /> CONTRACT PRICE OF WORK Z� G �� 2S- - CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> WCRKOESCRIPTION � - � ' • - � <br /> RGmo�t cxiS��.,� �p.� c1,4r.�.cf lC H�+ S C� 1 Sc{ S L ��a.SI��C C�- 1 <br /> Si�N [1S�u.{5 <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 /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITC4EN SINK 8 D�SPOSAL _ CLOTHES DRYER <br /> DISHWAStiER _ RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> UHINAL 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 CEFITIFY THAT I HAVE REA��ND EXAMINED THIS APPLICATION AND KNOVJ THE SAMG TO BE TRUE AND CORFECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVEfiNING THIS TYPE OF WOFK WILL BE C�MPLIED WITH WHETHER S?ECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PC-RMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> Sl Al'e OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEC BY THE <br /> OWNER OF THIS PROPERTY T PERFORM ORK F HICH APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br /> CONTRACTORS LAW 1027 . W AND .2 <br /> Signature wn ntractodA honzed Agent � D te� �/ <br /> 1 <br />