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��RMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810 — FHX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# P/ERjMIT# I <br /> �2C j! -,p1 C'/d/ I� C�'>>SL•GC6J /%Gc7 ( _rJ� ;,� <br /> LEGAL LOT NO. BLOCK TRACT <br /> oEs�. r nin��i��aN1 ie��'rr �;a�r/oN <br /> OWNER ADDRESS ZIP PHONE <br /> h��/ / �TC���NG'r� �I '72L lI���G��%����j �1r ���,�Rfi�� �orr 98z�3 �2>' l�� –�gGl <br /> TENANT NAME I CONTAI.T FOR PERMIT PHONE <br /> Q l `�h� f,(t�rGUND �f'z5 - 2�z-F�37C <br /> CONTRACTOR ADDRESS 21P CONTR.LICENSE� <br /> . ., �rtc7 r��������zY� ���� �=c�r.h�cr�, �U�a . ��-z-�3 Jf�EclSfr'1997D¢ <br /> �,�� �Gl�>>�ea'� /'?�i,�iKG <br /> PHON �� /rn/�s� <br /> � <br /> ����- ����y -���� �� 9,� <br /> PROPOSED USE OF BUILDING f,l Building r) Mechania� Addilion HEAT SOURCE <br /> > + PERMIT � � Combination D Plumbmg WORK Alteration Q Electnc <br /> �iN�-�r� /l�i'���Y I��S���N�,� TVPe �l Demoiition L� Sign rvre New �..j,Gas <br /> U Sprinkler RepaidMaiN. C,�� � Other <br /> CONTRACT PRICE OF WORK �� �j� — CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> (�t� r,'�"C' �L'%� �� <br /> WORK DESCRIPTION i Lc-�N- CD�Y�'��7 �'XlSr ^7PR P�R! l/"rt li9 RRGE- ���"X z� � -fc-:z 5;f - G,32S — <br /> /}Pl•YrI�N ta✓r')'k���� r/` zPx ?� ' E'f[ ,.�� �c8371o, — <br /> i)DP�T/�/. . � ���,�h (=u: F'��'K � � �P'= 2z� G,F �f Z��o — <br /> ��-��lrlil`� �r lw/i/N r'� Dff�. ,��!'� `ii�`' �� � 9� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I WATER CLOSET(TOILET) _ AIC–A/HANDLING UNITS <br /> I BATHTUB _ FORCED aIR SYSTEMS <br /> �L LAVATORY (WASH BASW) _ HEAT PUMP <br /> I SHOWER _ UIJITHEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRYTRAY _ 'VATER HEATER <br /> CLOTHES WASHER _ �46TAL FIREPLACE/STOVE <br /> � URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN y_ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS R,4NGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER J,_ OTHER (-c(1'/�%Or� <br /> — — I <br /> �i I HEREBY CERITIFY THAT I HAVE READ A�D EW+MINED THIS APPLICATION AND KNOW THE SAh1E TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF I.i1WS AND ORIDINACES GOVERNING THIS TYPE OF WORK 6VILL BE COMPLIED WITH 4VHETHER SPEGFIED HEREIN OR <br /> ' NOL THE GRANTING OF A PERMIT DOES NOT PRESUAIE TO GIVE AUTHORIN TO VIOIATE OR CANCEL THE PRO\'ISION UF ANV OTHER <br /> ; STATE OR LOCAL LAW REGULATING CUNSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY 7HE <br /> ' OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR 1NHICH APPLICATION IS MADE AND I COMPLY 1VITH THE STATE <br /> I CONTRACTORS lA1y 18.27 RCW AND 296?00 N'AC. <br /> i <br /> ��. ,,� �� ,��>�(-�.�( q/�.�l��r �l�r �G� <br /> Sighature of OwnTContractor/Authodzed Agent Date I J <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED � <br />