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P �'RlVIIT APF�LICATIC�N <br /> CITY AF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> P03 0 C�-DOS' <br /> SITE ADDRESS PARCEL TAX I.D.# I P RMIT��� # -� <br /> Lzol Mo�sec� p�,yC, -�—s�� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> 6vt�-�-1 N Kf�otS 2201 Wic�12D� A'� <br /> �-r2s • �3 �c�59� <br /> TENANTNAME CON7ACTFORPERMIT PHONE <br /> I bC�r-) �A�w\ �.�i ' '!S`�' ��I <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE M <br /> PHONE�c�t.�U�^' '�1�7W.�NEa 1'��j�I � I S�� `�Z7C7 ��W 1��� L� <br /> �i-7 S ' �`f• I��'L I 2�-F 2 �T(NC� � • <br /> n�lt!✓�cs�ficA.r wQ . (0•!2' (� <br /> PROPOSED USE OF BUILDINr Building Mechanical Additlon HEATSOURCE <br /> PERMIT R Combination � Plumbing WORK �Altoration � Elecuic <br /> TYPE D Demolition S(gn TYPE New Gas <br /> U Sprinkle� Repair/Mafnl. Other <br /> CONTRACT PRICF OF WORK �.-j����-- CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 '� <br /> �r <br /> WORY,.,wCRIPTION <br /> IN��TQaA'�1 O'� NC.�J �j�TC.RV� 1 N <br /> ��P� rv� r-�C w��cc�L�� ov�-S �{�"�`'' I►r�.vP�N� ,�w <br /> t 1�-(N(�x, - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO.. TYPE OF FIXTURE OR IT'M <br /> � WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> _L BATHTUB FORCED AIR SYSTEMS <br /> _L LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUivDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINHL FIREF'.ACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DR41N GAS RANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE?;<UE AND CORRECT. ALI. <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING?HIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTIN3 nF A PERMIT DOES NOT PRESUME:TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> S7qTE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br /> nYVNER OF ' S PROP TO FORM THE WORK FOR WHICH APPL�CATION IS MADE AND I COMPLY WITH THE STATE <br /> A ORS RC AN 296.200 WAC. <br /> I � <br /> �— • 23-03 <br /> Si a e of Ow r( racto uthorized Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />