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s <br />SITE ADDRESS <br />/U/D/�i2Z� ,c�,� <br />LEGA LOT N0. <br />oEs�. �6 <br />OWNER <br />�J�� „�Xi �` <br />TENANTNAME <br />CONTRACTOR _ n ��� <br />��;RMIT APPLICAT��N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />�� , �li�i� /,G�• <br />BLOCK TR <br />�7 <br />AO <br />/711�,�,,�„ G.r�/.� <br />PHONE �-��0� 7�7 %�a,r <br />PARCEL TAX I.D. # <br />G y700Gb <br />1 <br />ICONTACT FOR PERMIT /�„�� ,/�� _�/ oPH�� 7� <br />T7Cz�i,� ��.���C, �.r��C-�J) 795/- 7/�S"_ <br />ADDRESS <br />�oG � z.� C�.����� a� <br />,��o. ��. izs� .l �v�. <br />ZIP CONTR. LICENSE d <br />�.4n�1�mG <br />i�27Z zzo�0 <br />PROPOSEDUSEOFBUILDING ��r�c1 Building Mechanical Addition HEATSOURCE <br />/ ,, � PERMIT �) Combination R Plumbing WORK � Al�eration n Electric <br />� ��>�. ��� ' TYPE Demolition [� Sign TYPE New Gas <br />�'� � B Sprinkler RepaidMaint B Other <br />CONTRACT PRICE OF WORK �O� �-� 00 CITY OF EVEREl7 LOCAL SALES TAX COOE IS 3105 <br />1YORK DESCRIPTION <br />i <br />�„�_�-� _ _��=r= _ <br />N0. I TYPE OF FIXTURE OR ITEM <br />WATER CLOSE � <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICErBAR/MOP/ETC.) <br />OTHER <br />�-.s'Zr�T- �� �/�'�-! � <br />��� <br />N0. I TYPE OF FIXTURE OR ITEM <br />NC -A/HANDLI�� UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />_ UNIT HEATERS ��� <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GASRANGE <br />GAS PIPING <br />E;(HAUST FAN <br />OTHER <br />I HEREBY CERITIFV THAT I HAVE READ AND EAAtdINED THIS APPUCATION AND KNOW THE SAIdE TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF I.AWS AND ORIDINACES GOVERNING THIS TYPE OF WORK IYILL BE COA7PLIED WITH WMEi HER SPECIFIED HEREIN OR <br />NOT. THE GRAN7ING OF A PER�dIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGU WTING CONSTRUCTION OR THE PERFORI.tANCE OF CONSTRUCTION. THAT I Ah1 AUTHORIZED BY TFiE <br />OWNER OF THIS PROPEFTV TO PERFOR�d THE VJORK FOfl WHICH APPLICATIOIJ IS IdADE AND I C01.1P1.Y WITH THE STATE <br />CONTRACT� LAW 18 °7 RCW�IND 296.200 WAC. <br />� % ,�I/1/,!�� ,�-�rrl--� `1�,��3 <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />�/ z <br />