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PERMIT APPLICATION <br /> CITY OF EVFRETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-757-8610— FAX 425-257-8857 � e� `p� ( <br /> � ��� <br /> SITE ADDRESS PARCEL TAX�.D.# PERMiT�# <br /> I<-�� � , .,� _��'li �I 'r_'c�: )' .�`��'��}�)'z -Uc� -� UGj -C�t. �`� �i'I-�� <br /> LEGAL LOT NO. � BLOCK TRACT 1 ��l�� <br /> DE50. .![.-�L�. �\���ChCG7 � �� <br /> OWNER ADORESS ZIP PHONE <br /> I I -l�,Il`�t�_t /�=' ��:�_��,� �,�� �3t, �� ,�,<� �� . _ .2..��� � �,��: �_,�a�-c�, �.�, �. �� �l ���,� � <br /> TC�ANT NAME CONTACT FOR PERMIT PHONE <br /> I �� ���nr��, ��� �"1��, �� rt'1 ��.I-,�� �- 1 r�-���,s l � ., �t.�:�� ��-�{� � �- ���. � <br /> CONT� � ADDRESS � /� ZIP CONTR.LICENSE# <br /> � �� �- C.` 1��7 ,�J�1.' C�.._}�L:� \ :�� ,`7�. � ., -� .�l ��o�` ! '�ll� ��` 1C- � <br /> PHONE . <br /> _-�. � _. ,, �-; E-, �>. <br /> PROPOSED USE OF BUILDING �Bwlding I7 Mechanical Atldition HEA7 SOURCE <br /> PERMIT Combination F_� Plumbing WORK Altcralion �Electric <br /> � TYPE � Demolition IJ Sign TYPE �New � Gas <br /> �` � � 1� l, � l�C ��,� � r l l%1 Sprinkler Repaldhlaint. Othcr <br /> CONTRACT PRICE OF WORK 't �� ' �l � /'����`; CITY OF FVERETT LOCAL SALES TAX CODE IS J105 <br /> L ` l <br /> WORK DF.SCRIPTION I�I� . l,\� .��� � �J�-, � � �� I� I - l_; 1�� C�.�C�,"�� ><. _ ��� C. 1�%`�� . �c� 1i rI <br /> 1 � ' I <br /> _ r�-,, �,.-,c.� -7.�� Jv��� <br /> L�'�" �� --O/� D��,, �n ��ii� 1 �o<'c �1�� S ��� _ � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITFM <br /> (- - WATER CLOSET _ NC-AIHANDLING UNITS <br /> - - BATHTUB FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) = HE4T PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL . CLJTHES DRYER <br /> - DISHWASHER � RPNGE HOOD <br /> L AUNDRY 1'RAY Wl�TER HEATER <br /> -� CL7THES WASHER METAL FIREPLACEISTOVE <br /> URINAL � FIREPLACE INSERT <br /> �T DRINK!NG FOUNTAIN _ GAS FIREPLACE <br /> �'� FLOOR DRAIN GAS RANGE <br /> �: �BACKFLOW��PREVENTER GASPIPING <br /> SINK(SERVIGEIBAR/MOPlETCJ EXHAUST FAN <br /> '�— OTHER � OTHER <br /> — � — <br /> I HEREBY CERITIFY THAT 1 H�VE RE�D AND E%AMINED THIS�PPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. �LL <br /> PROVISIONS OF L/1W5�ND ORID;NACES GOVERNING THIS TYPE OF WORK WILL BE COA1PLIED WITH WHETHER SPECIFIED fiEHEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOFS NOT PRESUAIE TO GIVE AUTHORITV TO VIOUITE OR C�INCEL THE PROVISION OF ANY OTHER <br /> STl�TE OR LOCAL LAW REGULl�TING CONSTRUCTION OR TI1E PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 6Y THE <br /> OWNER�OF THIS FtOPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS A1ADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS �Y 18.27 RCW D 29G2J0 WAC. / <br /> �%� _ � ��- �" l / I:S�C�/�- <br /> , Signature ol wner�Contractor�uthonzed Agent /Date i <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED (Z <br />