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P�.�MIT APpLICATIC J � ��� ' <br /> , <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET. EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 /� = <br /> 7/d��er.,�'f.x� /3v3�L-oo� � <br /> PARCEL TAX I.D.Jt PERM17 N <br /> SITE AD�o,FiESS �, 7_�;�� ; <br /> 3�1�"��� ,� Z9oT2 uo o .5au -3/� �' <br /> LEGA L T NO. BLOCK TRAGT } <br /> OESC. � <br /> OWNER AOORESS aP PHONE <br /> �-U �rc! Cn��v�, 7� 3201� / 7 i h�n)v° �✓ Jrc ��F K/..f S�`i /S� _ <br /> TENANTNAME CONTACTNAM PHONE <br /> (� /G � � �n � I -�„ ^ �Tsoa � `-/z�1;6a2• '�J✓l <br /> CONTRAC OF n �/��SS� � ZIP CONTR.LlCENSE M <br /> �(i'Lr ��l��4.� i uY �v l��" M m cJ� u/G9 l��O�.J/7�/II�,l L3 [/�l <br /> PHONE r I LI^ �Q Z 'y)� l <br /> `'l <br /> PROPOSE�USE OF BUILDING � Buildi�g Mechanical Additicn HEAT SOURCE <br /> PERMIT Cambination�Plumbing WORK �Alteration �ectric <br /> � / TYPE Dem01iti0n � Sign T'PE New Gas <br /> � /'� � � Spnnkler Repair�Maint. Other <br /> � ,� <br /> I CONTRACT PRICE OF WORK � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WOqK DESCRIPTION r�� f��� y�//�f C �/ v�tii+f <br /> PLUMBING MECHANICAL <br /> � NO. TYPE OF FlXTUflE Ofi REM N0. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET _ A!C—A/HANDLING UNITS `�` / <br /> BATHTUB FORCED AIR SYSTEMS . �iT� <br /> LAVATORY (WASH BASIN) ?— HEAT PUMP n <br /> SHOWFR UNIT HEATERS �� <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES ORYER (� � <br /> DISHWASHER _ RANGE HOOD \ ' �\\� <br /> LAUNDFiY TRAY _. WATER HEATER �, a <br /> CLOTHES WASHER _ METAL FIREPLACElSTOVE \%\ . <br /> URINAL • _ FIREPLACE INSERT \� <br /> DRINKING FOUNTAIN _ GAS FIREPLACE , <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER .� GAS PIPING <br /> SINK (SERVICFJBAR/MOP/ETC.) � EXHAUST AN <br /> OTHER L OrHEA I����� �^J <br /> — �_ i%/� c /1•,, �N �J <br /> — L ,f�o/ r�_ <br /> I HEFEBV CEFITIFY'HAT 1 HAVE RF�1D AND E%AMINED THIS APPLICATION ANO KNOW THE SAME TO BE TFUE AND CORPECT. ALL <br /> PROVISIONS OF LAWS ANO ORi01NACE5 GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITM WHETHER SPECIFIED HEREIN OF <br /> $�qT pq GOCAI ILAW REGULATING CONSTAUCTION OF THE P RFORM�N E OF CO STR CT ON.CTHAT I AM AUTHOFi1ZED BY THE ER <br /> pWNER OF THIS PfjOPERTY TO PERFORM THE WORK FOfl WHICH APPLICAT70N IS MAOE AND I COMPLY WITH THE STATE <br /> CONTfl TORS �N 1827 F3GW AND 296200 WAC. <br /> � � � �� � Z. ' � �O � . <br /> Sign'lure/ofOwnedContractodAuth zedAgent Date � <br /> ,�� c'��;.:.Ci�L: <br /> 'r'7r�J��9;"�S'QS��•- . <br />