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11 <br /> PERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES � � �' �o � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ! <br /> 425-257-8810 - FAX 425-257-8857 <br /> Couo7-ola I <br /> SITE ADDRESS PARCEL TAX I.D,p PERnvT tt <br /> /✓ i /�7 `�U � <br /> ! � /��o�z�v�E vi6w Ua:v6 00� 3�' - �a7 • 603 - O/ � �1 <br /> LEGAL LOTNO BLOCK TRACT „ <br /> DESC. y�,.�.7'`:��' �F Z2� /��li/SiOrv j �� VOLwrv� N � /�A6E 3Q <br /> OWNER ADDRESS 21P PHONE I <br /> GH 2� tJO� �,c/t� 112Z C Mr7�z��vE� ViFw Oa�i'�. `t&2�1 t/�'S-iSo� '7'NGQ I <br /> TENANTNAME CONTACTFORPERMIT PHONE II <br /> 'Sp ,v.s I GAz�C Yoo6+� �las-s.�a. - abcy' <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# � <br /> � <br /> Ow/�f.�t LN�L- C. rJ0 n+ r.L wGn+iC � <br /> PHONE <br /> PROPOSED USE OF BUILDING Building fl Mechanical Atldition HEAT SOURCE <br /> PERMIT Combination �-� Plumbing WORK Alteretion I� Electric I <br /> S�we�-e FA�4 �+- Y F-< �-Z� <br /> TYPE Demolition LJ Sign TYPE New }�p Gas <br /> �.��aE;��E Sprinkler RepaidMaint. U Other <br /> CONTRACT PRICE OF WORK C.�7 � -� 5•OQ :' CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORKDESCRIPTION /'t,EiYluvE= CR�:i7�NG [.t//+�-t� Go"�'-"i'iNL q 'C'4^�c•AGE �4' •iN NF.a�+ .7NCCTRw: <br /> J <br /> /rli:7YJ�-L NF.tir .�.-•Ir /N:;.a.t.�T�uN ✓a-.:� CIGTG:,.�(�Il. CNA�-��J �CF�_.4GE FM:n.7 P� $•'�C.K <br /> F7u�r,ti:�J /C-GFtn �-F .la.:, u./�..inOwS .., r'7N C,<. . 3 ,5' Gar-,�r.c �'E..'.-AGE ni... 1�10..AT�..'.y FiX7K e� <br /> 9i R� 7C.Nc.v c:nd..�a :a, /CF-..:��.,iE Y .C.So:.nr.F: ...w . .,'ranrsO «.-..�.�:� tioo.�....(,� Kin, /CE�MJJ6 I <br /> H� � w � �A.�ne - <br /> ,u•sti�,� S,o•�•c. LUMBING MECHANICAL I <br /> :JR�/l:�NO <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 I <br /> LAVATORY(WASH BASIN) HEAT PUMP � <br /> �, SHOWER UNITHEATERS I <br /> �' KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER � <br /> �r'i•/1l.EJ��c:.VT <br /> DISHWASHER �_ RANGE HOOD <br /> LAUNDRY TRAY 6 F � WATER HEATER CFr:1 I <br /> � CLOTHES WASHEP. C,��= T r�v 6 FIREPLA EE SERTSTOVE <br /> URINAL <br /> _ DRINKING FOUNTAIN �,_ GAS FIREPIACE Gn� N��s,v ���„�, I <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER � GAS PIPING <br /> � _ SINK(SERVICEfBAR/MOP/ETC.) 3_ EXHAUST FAN(F�„M� �.(yy6' � 1 � <br /> OTHER OTHER � � <br /> — — � <br /> — — I <br /> — — i <br /> i <br /> , I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNON'THE SAA1E TO BE TRUE AND CORRECT. ALL j <br /> i PROVISIONS OF LAWS AN�ORIDINACES GOVERNWG THIS NPE OF N'ORK WILL BE CO�.IPLIED WITH INHETHER SPECIFIED HEREIN OR � <br /> �� NOT. THE GRANTING OF A PERh11T�OES NOT PRESUNE TO GIVE AUTHORITY TO VIOLATe OR CANCEL THE PROVISION OF ANY OTHFR <br /> � STATE OR LOCAL LAW REGULATIN.. JONSTRUCTION OR THE PERFORMANCE OF CO�STRUCTION. THAT I AM AUTHORIZED BY 7HE � <br /> � OWNER OF THIS PROPERTY TO PERFORAI T WORK FOR WHICH APPLICATION IS MADE AND I COA9PLY bVITH TH2 STATE � <br /> � CONTRACTOHS LA 8.27 RCW AND 6.2 11'AC. ; <br /> I �G � I <br /> Signatur w iContra �A - �ed Agent Date � <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED �Z i, <br />