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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, �VERETT, WA 98201 <br /> I 425-257-8810— FAX 425-257-8857 S ` � �0 N <br /> i <br /> SITE ADDRESS PARCEL TAX I.D.# PERMi7» <br /> 1910 'YIeRR� II �cl� PKw D oa • �C 5 -0�� � <br /> LcGA LOT NO. OLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> 2a3� v �p� " ave , S.F. <br /> 1n+rti. 2A-lccl � ( n .� , .�eS do-t�E f I 1.7V� 9 gD�l `la.j-� `IR� -�88 <br /> TENANT N ME CONTACT FOR PERMIT PHONE <br /> -1- �e2�a �-Iel Tr �� �loti �e� IV� i ! c �� n �c 3(�i7 - 6$ � ' 77� 1 <br /> CONTRACTOR u ADDRESS ZIP CONTR.UCENSE# <br /> Sn.�+l. F�a� Sys�a..�� 38i;; 168 ' " S� . r�. E. ''1 <br /> PHONE 9$�!� SMiT{.� FS �36oT <br /> 3b0 - ( � 1 .- 7701 �R- I n . +o I ) A <br /> PROPOSED USE OF BUILDING Building M1lechanical Atloiuon I HEAT SOURCE <br /> PERMIT R�-( Combination R{..( Plumbing WORK Alteration R Electnc <br /> 1'YPE �.j Demolition U Sign IYPE New �j Gas <br /> Q9 Spnnkler Repair/Maint. U Other <br /> CONTRACT PRICE OF WORK � y � 6 g� � CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> WORK pESCRIPTION <br /> .T„s�ail F�lCL SpRInK�GM1 S7s���+ ( 35z {�e�ds� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIYTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> WATER CLGSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISH�N.' .,yER RANGE HOOD <br /> LAUi - TRAY WATER HEATER <br /> CLO ✓JASHER METAL FIREPLACE�STOVE <br /> URINA. FIR[PLACE 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 /> I _ OTHER OTHER <br /> � <br /> '� i HEREDY CERITIFV THAT I HAVE REAO AND EXA6IMED THIS APPLICATION AND KNOW THE SAMG TO BE TRUE AND CORRECT. ALL <br /> i P?OVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF VJORK WILL BE COMPLIED WITH WHE7HER SPEGFIED HEREIN OR <br /> i NOT. l i1E GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTNORITY TO VIOWTE OR CANCEL THe PROVISION OF At�Y OTHER <br /> lSTATE OR LOCAL LAW P.EGULATWG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY 7HE <br /> i OWNER OF THIS PROPERTY TO PERFOR�d THE WORK FOR bVHICH APPLICATION IS MADE AND I COMPLY 1NITH THE STATE <br /> � CONTRACTORS LAW 18�27 RCW AND 296.2001'JAC. <br /> � ` -�a..io.- <br /> Signature of Owne 1Contrac'orlAuthorized Agent Date <br /> � D[BIT 8 CREDIT CARDS ARE NOT ACCEPTED ��7i, <br />