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� �ERMIT APPLICATfON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-25'1-8857 <br /> SITE ADDRESS -�`y� � PARCEL TNC I.D.# P RMi7# <br /> � o �D(o`cn-K�- �X oo�lln �l7 c�voo7a- o/ ,� p3 �D - orS <br /> � LEGA LOTNO. BLOCK TRACT <br /> oEs�. Q d�f� kua � ' <br /> OWNER ADDRESS ZIP PHONE <br /> �.yuuNiXa�7 � D�e NicL ;./r�,� 4�0� 1�i�6f /LD. 9�ao3 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> I�r�t�c 6 , c�.�rw�'�e�,.Tn.�. �ZS"- 3�13- �/2Z <br /> CONTRACTOR ADDRESS� � ZIP CONTR.LICENSE It <br /> l�,p�� o. ��+��oR J,T�c_ ��a� �'d���,e � d c /�� <br /> �HO E q&'� �GI/l�c � �OI�V' <br /> � 3 -�s►zv � k „ 3 <br /> PROPOSED USE OF BUILDING Building Mechanical Adtlitlon HEAT SOURCE <br /> G PERMIT Combination Plumbing WORK Alteratlon Electric <br /> C.y,�Sjl�� ��-'�o� TYPE Demolition Sign TYPE New � Gas <br /> Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK �j OGy-a � CITY OF EVERETT LOCAL SALES TNC CODE�S 3705 <br /> WORK DESCRIPTION ' ' �. <br /> �,��� �x�s�n�G rca9-T �F c� �,a��fd� � .e�l'� �� � <br /> �/�Z f�� rCNf17 /Qc-b� k £'XTfiJl� �°f�� D� GA��t6� (o I � tc <br /> � <br /> PLUMBING I MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO.. TYPE OF FIXTURE OR ITEM <br /> W4TER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYST[MS <br /> LA'JATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KIT�HEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DIS-IWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRI�KING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACk:FLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERiTIFY THAT I HAVE READ AND E'(AMIKED THIS APPLICA'fION AND KNUW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PkOVI510NS OF Ll�WS AND ORIDINACES GO\'ERNING THIS T'PE OF WORK'vVILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRPVTING OF A PERAIIT DOES VOT PRE��tdE TC GIVE AU'HORITI'TO VIOLATE OR CANCSL THE PROVISION OF ANY OTHER I <br /> ST TE OR UCAL LAW REGULATING CON57RUCTION OF THE PERFORMANCE OF CONS"RUCTION. THAT I AM AUTHORIZED BY THE <br /> O OF THi$PROPERTY�O PERFORM THE 1VORK FJR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT A �jS`.LAW 18.27 CW AND 2d6.2G0 WAC. <br /> � 7pw l�._�O_03 <br /> Sig � ot �vnedContra tor/AulYorized Agent Date I'L <br /> � <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> �—- ---- <br />