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�ERI�lIIT APPLICAT: �N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> /� _� 9- OZ <br /> SITE ADDRESS PARCEL TAX I.D.�i PERMIT a <br /> �30 � w,�„�� iJ;z �� .x Gz�� -v�7 <br /> LEGA LOT N0. BLOCI< TRACT <br /> DESC. <br /> OWNER ADDFESS ZIP PHONE <br /> l.Q/'i��i �J i� �S n <br /> TENANT NAME CONT CT NAME PHONE <br /> /J�I C�:a e:-/• �i�ci�� �L//� �✓O/�s.� �t' 7.S�Y S�oS�r-- <br /> � CONTRA OR C� �LL��ri3���p ADDRESS � . �� ZIP COIiTR.LICENSEM <br /> J � ��as- / -3 D�'l � .�x'rPG.� vii�-�,- <br /> PHONE %!� J �S/ Y ��Sl //�•�/� !J/�/L L�i�I� 9U �-�U <br /> PROPOSED USE OF BUILDING Building n MeChaniCal Addition HEAT SOURCE <br /> PERMIT R Combinalion p� Plumbing WORK � Alteralion � Electric <br /> TYPE � Demolilion LJ Sign TYPE New Gas <br /> Sprinkler Repair/Maim. Other <br /> CONTRACT PRICE OF WORK �JS-�-U `� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 7 / / <br /> WORK DESCRIPTION ,�� �-/r� /�j✓r�r bi�-7 -�o'l'� � /"G«-/C 7iZ�`'�- <br /> � � �� . � <br /> R �u• �� <br /> , PLUMBING MECHANICAL <br /> �I NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OH ITEM <br /> I WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> � SHOWER UNIT HEATERS / <br /> y KITCHEN SINK S DISPOSAL � CLOTHES DRYEFj��� � � <br /> DISHWASHER RANGE HOOD jX � <br /> LAUNDRY TRAY � WATER HEATER I � <br /> � CLOTHES WASHER _ METAL FIREPLACEISTOVE <br /> URINAL FIFEPLACE INSER7 � <br /> DRINKING FOUNTAIN GAS FIREPLACE -� <br /> i FLOOR DRAIN � GAS RANGE � �� <br /> BACKFLOW PREVENTER �_ GAS PIP�NG � � <br /> SINK(SERVICEiBAR/MOP/ETCJ ' EXHAUST FAN� <br /> � OT�iER ��'�� . / _ OTHER_ <br /> _� rt�K-,ac iii� _ <br /> i — <br /> I HEREBY CERITIFY'HAT I HAVE READ AND E�(AldINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS 7YPE OF WOFK WI�L BE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERti11T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCdL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> 06VNER OF TH PROPERTY T PERFORM THE WORK FOR INHICH APPLICATION IS 61ADE AND I COMPLY WITH THE STATE <br /> CONTRA T S WW 18. JJ ANO 296.200 WAC. <br /> '! ''_.� �-��'�'� <br /> S' nature of OwneVContractodAuthonzed Agent Date <br />