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1 <br /> -zz - �• i <br /> - P�MIT APPLICATfO� <br /> ' CITY OF EVERETT PERMIT SERVICES <br /> 320D CEDAR STREET, EVERETT, WA 98201 <br /> �Q�/ � 425-257-8810- FAX 425-257-8857 ��1�� <br /> SITE ADDRESS PARCEL TAX I.D. # PE MIT,Y i <br /> 1�-C-M►12w� v1 -L'N/ DRIdE I'7Z9d5 •-I- aG� - C�dO� J , <br /> LEGAL LOT NO. BLOCK TRACT � <br /> DESC. <br /> OWNER ADORE55 ZIP PHONE <br /> C;P�NPDLE PEVE1-OPME�iT 3�;y SAN Mi�1.. D�•�t35 ��p, <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> . C►Ma1.E5 MoitGpt� �}-2$-353-Zu�$ <br /> 73d+ fSL�l�.t-Y tat� I <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> PHO E�L �iac�T'-�C 32� A �-t��Maa ep 98'u-6 P I G73�-Fl,l <br /> F3t�.�.,r�cNqm , wA � <br /> PROPOSED USE OF BUILUING Building I� Mechanica� Addition HEAT SOURCE <br /> /�PAR.TML�IT �3LpG PERMIT � Combination �__� Plumbing WORK � Alteration � Electric <br /> �'�OR SCIv�02S T�"PE Demo�ition L� Sign TYPE New Gas <br /> Sprinkler Repair/Maint. Olher <br /> CONTRACT PRICE OF WORK (d,2I S' �3/� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 .J b <br /> WORK DESCRIPTIOY <br /> CzNS�ucri' A 2.59 uNIT ¢ S7oRi( w�BSAl7 IlP�27m�t�[7 8w-Ot�dG <br /> SEI�/-}�� -UD�� (»-r) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> = SHOWER UNITHEATERS I <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE I <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> — — I <br /> — — � <br /> � <br /> � <br /> ' I HEREBY CERITIFY THAT I HAVE READ AND EXAP.IINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL i <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING 7HIS TYPE OF\NORK N'ILL BE COhIPLIED WITH WHETHER SPECIFIED HEREIN OR i <br /> I NOT. THE GRANTING OF A PERA1IT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLA7e OR CANCEL THE PROVISION OF.�NI'OTHER <br /> STATE OR LOCAL LAW REGULATIN6 CONSTRUCTION OR THE PERFORM1IANCE OF CONSTRUCTION. THAT I AA1 AUTHORIZED 8Y THE <br /> I OWNER OF THIS PROPERTY TO PERFORM THE 4VORK FOR 1h'HICH APPLICATION IS MADE AND I COMPLY WITH THc STATE I <br /> CONTRHCT RS LA\V'18.27 RC1V AND 296200 WAC. � <br /> I � �.' �i 4 .t�K c�. I <br /> � SignaWre of OwnedContr todAuthonzed Agent Date I <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED �/2 I <br />