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( PE�2MIT APPLICATIO�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> � - � 2-oY <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT� i <br /> / � 7 _,n,E ✓�F�v o.�,vF �o �i3 7- z �.7 • 003 - D � U�-G3 ) � <br /> LEGAL LOTNO. BLOCK TRACT � <br /> OESC. Nnr�TN M'�'Li" � -� .7 /��v�SioM IT V6La.�.rv� n/ �] pr�ieF_ 3O <br /> F .�- 3 `- <br /> OWNER ADDRESS ZIP PHONE <br /> ��I7 �`� yOCF� i/J.?� C n,n.t.�vE ✓�Ew l�r_�vE `��G7.G+ l ��IZ.ri� 2.�i? • � (ci:'� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> Gnr�.`i' `�OfJFti GAP�`i' �GOE,r� C'-I1S� 251.-y (,c, �j <br /> OLti N�I 21P CONTR.LICENSE# <br /> CONTRACTOR ADDRESS <br /> PHONE OW tJc: :. w � �-L �JU nLl won.K <br /> PROPOSED USE OF BUILDING Building ❑ Mechanica� Addition HEAT SOURCE <br /> ������, PERMIT Combination U Plumbing WORK�Alteration n Electric <br /> TYPE Demolition U Sign TYPE IJew D Gas <br /> � Sprinkler Repair/Mainl. �D Qther <br /> CONTRACT PRICE OF WORK G���M l�7-EO C%�+'!" �/O�UUU CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION �,e.r� vF ER �+T iN6 wo•�D F".z-n.�^r: G�.qr�.ncC- � +��+�.T FWurt, a' <br /> IZG F a.i0 �F W ��7 1� IV fiW 1'd W 1 L 10 1 i�r � �� 7� � - /V O � CN i n. /iv 6J 6+�+ <br /> 32' <br /> /O:.w.v. r.i !�v 6 Ol. f�Eai � ni5 .`+ow�+.CE A i 'TN�S ^'�n, ,F <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C-A/HANDLING UNITS I <br /> BATHTUB _ FORCED AIR SYSTEMS � <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <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� OUNTAIN GAS FIREPIACE <br /> FLOOR DRAIN GAS RAN�E I <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE(BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER _ <br /> — � <br /> � I HEREBY CERITIFY THAT i HAVE READ AND EXAAiINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE A�D CORRECT. ALL <br /> I PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPEGFIED HEREIN OR � <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUAtE TO GIVE AUTHORITY TO'JIOLATE OR CANCEL THE PROVISION OF ANY OTHER I <br /> STATE OR LOCA�LAW REGULATING CONSTRUCTIO��OR THE PERFORMANCE OF CONSTRUCTION. THAT I FM AUTHORIZED BY THE � <br /> OWNER OF THIS PROPERTY TO PERFOP.M THE ORK FOR WHICH APPLICATIO�IS MADE AND I COAIPLY WITH THE STATE I <br /> I CONTRACTORS LAW 1 �7 RC6V AND 296. 0 C. <br /> , ..� l G %� U� <br /> SignatV� o(O racrod Agent ate <br /> � DEBIT & CREDIT CARDS ARE NOT ACCEPTED � � <br />