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P�RMIT APPLICATII. �V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE:T, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> S- aS -02 <br /> SITE ADORESS PARCEL TAX I.D.# PERMI7 w <br /> 1430 �. MAf2 �Nt= j�2. 0� 43 �327a � aloo �Z ��j'� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. 1 �{I�y� � z�B�oo �aS- 7yS- 6o6 � <br /> OWNER ADDRESS ZIP PHONE j�SN .Zo3 �O/Sj <br /> [. A�2 2`-( 1� ,o L. 5 0 , � q-3o �. M A 2��-t= L� 2, E.��TL�-t-�-� ! PsLo� <br /> TENANTNAME CONTACTNAME PHONE <br /> 3A/,n�= � inn '$�� Al� c �^� � (Do� plo,Q� - Z13 (o <br /> CONTRACTOR ADDRESS ZIP �� CONTR.LICENSE M <br /> 2'l00�{- �4� �.rE-. ��N� STA��oo � ��'Z�JZ S��nn�cRl r4-l �D <br /> PHONE (e Zo) �ZI '3� <br /> PROPOSED USE OF BUILDING fY�Building Mechanical Addition HEAT SOURCE <br /> PERMIT K{—( Combination Plumbing WORK RI--(�Alteration Q Eiearic <br /> FIZ,U t"T' � fa,12 (� L'r TYPE �j Demolilion Sign TYPE �New � u Gas <br /> L� Sprinkler Repair/Mainl. !.� Other <br /> CONTRA'_T PRICE OF WORK _ /i � p p'Z, CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> ���' <br /> WORK DESCRIPTION <br /> 3� � � ,� ��s� Fa�� � z�+ x� Z 3� a � � � � �- <br /> i 2_�. � L (_ c.� r�,-� _�c� <br /> PLUMBING MECHANICAL <br /> NG. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR Il'EM <br /> WATER CLOSET A/C—AfHANDL�NG UNITS <br /> BATHTUB FORCED AIR SYST[MS <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLCTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DFINKING FOUNTAIN . _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVFNTER GAS PIPING <br /> i _ SINK (SERVICE�BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> 1 HEREBY CERITIFY?HAT I HAVE READ AND EXAh11NFD THIS APPLICATIOh A�D KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF U1�V5 AND ORIDINACES GOVERtJING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEfih11T DOES NOT PRESUAIE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULAT:NG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR�ZED BY THE <br /> OWNER OFSHIS PROPERTY TO PERFORh1 THE WORK FOR WHICH APPLICATION IS h1ADE AND I COMPLY WITH THE STATE <br /> CONTRACJtlRS LAW '827 RCW AND 296200 WAC. <br /> C1 / �i /� <br /> %�ZG1 �7�• /`7�Lr� L .zG�O� <br /> Sig ature of wner/Con ctodAuthorized Agent % Date � <br /> I Z. <br />