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� �I <br /> P�RMIT APPLICATI(.N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810— FAX 425-257-8857 <br /> SITE ADDHESS PARCEL TAX I.D.N PERMIT x �, <br /> ��'�l ����.�_. �I �✓. �5 4 � OU Zc Soc� ,��:� - c �� <br /> LEGA LOT N0. /� BLOCK TRACT <br /> DESC. �j t ` �L' Z• PI fJ� �'I U2'.-�T— <br /> OWNER ADDRESS LP PHONE <br /> l�l,�, iu N i�-1_t-.5� �' ;� 19Q� 1�1E.LVIr.i At/, 982.D3 yZS•355�• 534� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> t�'�`� I D►�J�D � ILLCS'rA� �{tS• ZI g • 32$ 3 <br /> CONTRACTOR j[� � i�- ADORESS ZIP CONTR.LICENSE N <br /> PHONE <br /> PROPOSED USE OF BUILDING Building I� Mechanical Adtlition HEAT SOURCE <br /> � PEHMIT � Combination �–� Plumbing WORK � Alteration � Electric <br /> ��1�'��1�%P� � �� �r�" 7ypE Demolition � � <br /> LJ Sign TYPE New Gas <br /> Sprinkler RepaidMaint. Other <br /> CONTRACT PR10E OF WORK : �{' h(�O //�/�9 CITV OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> WGHK DESCRIPTION <br /> t.il ' ,,r � � �r��„r, l ni �A�- i• L-G' W ��� � '{ �iJ i=vG1 W �GE DOOIt . <br /> �''� l<Jt�, ; � �� :,�_ �".� �,--i 1 (�v, ���Cir.� A-*JD S7L'P_hbC O� yh, 'tiD 'tUDLS• <br /> PLUMBING MECHANICAI <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF fl7CTURE OR ITEM <br /> WATER CLOSET A/C–A/HANDLING UNITS <br /> BATHTU� ! FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER � UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> I DISHVJASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE I <br /> URINAL FIREPIACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PFEVENTER GAS PIPING <br /> SINK(SERVICE/BAR/610P/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> — — <br /> I I HEREBV CERITIFV THAT I NAVE READ AND EXA1dINED THIS APPLIGATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL � <br /> I PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OF <br /> iNOT. THE GRANTIIJG OF A PERId1T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR GANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM.AUTHORIZED BY THE <br /> OWNEF OF THIS PROPERN TC PERFORM iHE INORY.FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOHS LAW 18.7_7 RCW AND 296.<00 WAC. <br /> I � <br /> ISignawre of OwnevContractouAuthonzed Agent Date I <br /> I �� <br /> '. DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />