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! <br /> cT � � <br /> �ERMIT APPLICA1tiON <br /> CITY OF EVERETT PERMIT SERViCES ', <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 �1 � 3r ' ' 0�.3 I <br /> W <br /> SITE ADDRESS PARCEL TAX I.D.M S V P RMIT x <br /> I 3� PLC 5 . GY�`13 �z26 ��800 �o3-oi3 �j �-� �- <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. `� p�a 6 <br /> OWNER ADDRESS ZIP PHONE <br /> H�aAck � c�os, 39aa 8����E.�E ��.k� �aos yZ��n-�3eo <br /> TENANTNAME I C�TFOR��� yZs"a9b-a�a�t <br /> HA p,ct� �5 � r; .-,.. <br /> CONTRACTOR ADORE S ZIP CONTH.LICENSE M <br /> t�a�ck B�s 3qaa s�� �„E tit ��Ec�� a�°s HAR�46'=c�\2DZ <br /> PHONE <br /> �IZ,$-3n�-�360 <br /> PROPOSED USE OF BUILDING E3uilding � Mechanical Addition HEA7 SOURCE <br /> PERMIT � COmbination Plumbing WORK R Alteration � Electric <br /> � F � TYpE Demolition Sign TYPE � New Gas <br /> Sprinkler d Repeir/Maint. Other <br /> CONTRACT PRICE OF WORK ^70 '��� �Q�7S � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> / <br /> WORK DESCRIPTION / 7j C S , <br /> J <br /> �J E� S F � �� ? <br /> �/�3 I� �a�a <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM N0. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UI�ITS <br /> � BATHTUB � FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWEF UNIT HEATERS <br /> � KITCHEN SINK& D�SPOSAL = CLOTHES DRYER <br /> L DISHWASHER �, RANGE HOOD <br /> LAUNDRYTRAY L_ WATER hcAT[R <br /> � CLOTHES WASHER _ METAL FIREPIACE/STOVE <br /> URINAL _, FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN �_ GAS RANGE <br /> BACKFLOW PREVENTER �_ GAS PIPING <br /> SINK(SERVICE/BAWMOP/ETC.) ,� EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAFAE TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERPAIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTNER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHURIZED BY THE <br /> OWNER OF S PROPERTY TO PERFORM T E 4VORK FOR WHICH APPLICATION IS 67ADE AND I COMPLY WITH THE STATE <br /> CON CTO W 18.27 RC ND 296.200 AC. <br /> _ � _p <br /> Signa re of ner/ ontract u riz Agent Date <br /> B T & CREDIT CARDS ARE NOT ACCEPTED /Z <br />