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PERMIT APPLICATIC& <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR 588110 STREET, 98201 <br />5- FAX 425 257-885 <br />4 <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />/P MIT <br />��2E r <br />00 3 i z <br />LEGAL LOT NO. BLOCK TRACT <br />DESC. I r Ito g�L% Q-U2 L C2C-`Tr 6,u ff <br />OWNER ADDRESS ZIP PHONE <br />gbU3G. <br />Sr'c,c'ccl? C` � Sr'rr�cc �'��� .SIC S- :SW �yn�w•, >d �/.2�7.3�-/3-6/3 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />�19 w1 E (:�_j sacN<< /a5 ) '3 el3 - C�3 <br />CONTRACTOR ADDRESS ZIP CONTR. LICENSE # <br />si C e,GC(Z StD�tiJCt A(0 Si SrJ L'ynv1 WL'J <br />PHONE C C �3 <br />PROPOSED USE OF BUILDING cUilding ®® Mechanical I Addition HEAT SOURCE <br />PERMIT Combination 1LQ Plumbing WORK Alteration Electric <br />TYFE Demolition Sign TYPE New B Gas <br />nSprinkler Repaii/Maint. Other <br />�SI�G.lc 1=d9�. ticl� — <br />7 <br />CONTRACT PRICE OF WORK / 5 cat C r Y� /r�r/�j <br />J <br />CITY OF EVERETT LOCAL SALES TAX COD2 IS 3105 <br />WORK DESCRIPTION <br />-To cc, ,.»:jaQC Y1 61n)G-17b A <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />3 <br />WATER CLOSET (TOILET) <br />A/C - A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />q <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />i <br />KITCHEN SINK & DISPOSAL <br />I <br />CLOTHES DRYER <br />DISHWASHER <br />t <br />RANGE HOOD <br />LAUNDRY TRAY <br />t <br />WA ER HEATER <br />I <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />URINAL <br />FIREPLACE INSERT <br />DRINKING FOUNTAIN <br />V, <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />1 <br />GAS PIPING 1i/ <br />_ <br />SINK (SERVICE/BAR/MOP/ETC.) <br />q <br />EXHAUST FAN <br />_ <br />OTHER <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED HIS APPLICATIGN AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND GRIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />NOT. THE GRANTING OF A PERMIT <br />STATE OR LO(;AL LAW REGULATING CONST CTION OR THE PERFORMANCE OF CONSTRUCTION, THAT I AM AUTHORIZED BY THE <br />OWNER OF FI(S PROPERTY T ERFORM T WORK FOR YVHICH APPLICATION IS MAGE AND I COMPLY WITH THE STATE <br />CONTRACTO LAW 16.27 RC D 296.200 V C. <br />Signature of O� r/Contractor/Authorized Ag nt Date r� <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED / <br />