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P�RMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE AUDRESS PARCEL TAX I.D.# P RMIT� <br /> I �f IS (�o�SFeJ�ar�ro C1'Q,r�{Y�-q82�I �75Y2 oo07D000 �3 �- °`��' <br /> LEGA LOTNO. BLOCK TRACT <br /> oesc. + cess S 2q(7 p-o� tFlLrtU�tS �nol h�d� T'� EYc�� <br /> OWNER ADDRESS ZIP PHONE <br /> �or Q,h so�t � 1 �I S Ro�� � (�rP �YQ►�� �� `�$�°1 N2 5-870-2�4� <br /> TENAN NAME CONTACT FOR PERMIT ��5� PHONE �O <br /> 5'4 n� e I Ke�� C�„n���uw� lVva'�e�1' yzs —338 � <br /> CONTRACTOR qy.ppv MS Yi.��fp�1 �DRESS /�(F�(� SI !0 SE Z�P CONTR.LICENSE# <br /> T � � c. lolL/� <br /> I'' 0 <br /> PHONE II'L / — ���2/�� �QYG� Y�' � �g2 �QW�O <br /> '1 <br /> PROPOSED USE OF BUILDING Building tvlechanical Addilion HEAT SOURCE <br /> /� PERMIT R�–( Combination � Plumbing WORK �Alteratlon n Electric <br /> �,!� TYPE �–( Demo�ition U Sign TYPE New � Gas <br /> � l e 5 V Spfinklef Repair/Maint. Other <br /> CONTRACT PRICE OF WORK g?>OU -�' CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTI9 NJ ryn( • ,y � ' {7a��9 �K�,� � � Q�/(1G Q <br /> Fc�uKGiR�J(DH ► I4�Q/N V <br /> �9P(�4 u ����b <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C–A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TR,4Y _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACEISTOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPIACE <br /> FLOOR DRAIN _ GAS RANGE <br /> B.4CKFLOW PREVENTER _ GAS PIPING <br /> SINK(SrRVICE/BARIMOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> i — <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. A!L <br /> I PROVISIONS OF LAWS FND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERh11T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> OWNER OF�HIS PROPERGUTOTPERFORM THE WORK FOR WHICH APPL^CATION IS MADE AND I COMPLY W TH THE S�TATE D BY THE <br /> CONTRACT RS W iB. W AN 96.200 WAC. <br /> ✓,� z ,� 7��—��� <br /> Signawre of O �nedContractor/ uthorized Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED �Id <br />