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I P MIT APPLICATIGiV <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 (� .-'�1� O C,� I <br /> 425-257-8810 - FAX 425-257-8857 <br /> I <br /> SITcE� ADDRESSN� I PARCEL TAX I.D.# PERh7iT� <br /> 1_I�v I�IE�{.-'lll W !/� �1C�D "c�a— <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE � <br /> '�y T�_ Ic(�c� ��{-cR-►'-�11 C(tr�K 1'1�w`t �T �� 8?A3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �sa,,k�� I �.o-� ��t�c��+x,-J 2zv,� - �11 b -22�3 <br /> CONTRACTOR ADDRESS 21P CONTR.LICENSE li <br /> T'„��-r wt�u��cn�. t.tc_ 2z-�3 33 a��.k.►I -�vT F�� <br /> PHONE �STi��� �✓�- 9b'aZl T^�Twi�l..�tbllkl <br /> PROPOSED USE OF BUILDING Building �Mechanical Atltlition HEAT SOURCE I <br /> PERMIT � Combination Plumbing WORK �Alteration �Elec!ric <br /> 7YPE Demolition Sign TYPE New Gas <br /> Sprinkler Repa�r�Mainc Other <br /> CONTRACT PRICE OF WORK �p�� 'b-�� CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 I <br /> i• <br /> WORK�ESCRIPTION ' <br /> '� � Z. S �a�'-r�.� �lv R� Ua�TS w I t�qs ��p, .� � <br /> Z v n��'C ��F��"�=F�S � GXk\Av ST TAhf S / Z LL,�I��'ieS I <br /> PLUMBING MECHANlCAL I <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM � <br /> WATER CLOSET(TOILET) A/C–AlHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER 2 UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE � <br /> URINAL FIREPLACE INSERT ' <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE \ , <br /> BACKFLOW PREVENTER �_ GAS PIPING `�1aE.��C`n�15 J <br /> SINK(SERVICEIBAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> _ I <br /> I <br /> � <br /> � I HEREBY CERITIFY THAT I HAVE READ AND EXAAIWED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL I <br /> � PROVISIONS OF LF�WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COAIPLIED WITH WHETHER SPECIFIED HEREIN OR � <br /> . NOT. THE GRAN fIG Of-A P�RMIT DOES NOT PRESUAtE TO GIVE AUTHORITY TO VIOLATE OR CAN,:EL THE PROVISION OF ANY O�HER i <br /> � STATc OR LOC LAW RE LATING CONSTRUC'i ICN OR THE PERFORMANCE OF CONSTRUCTION. iHAT I AM AUTHORIZED BY THE <br /> � OWNER OF T '�{7 1�PE 'TO PERFORM THE WORK FOR WHICH APPLICATION IS PdADE AND I COMPLY WI7H THE STATE I <br /> �' CONTRACTO � - 1 RCW AND 296200 WAC. I <br /> ;/ •/i� � � 9 i <br /> i <br /> Sig . ur f 0'wner/Contractor/Authonzed Agent ate <br /> DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED � <br /> �� <br />