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I'��RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRES$--� 'G 6 <br /> % �� �f����� F PARCEL TAX I.D.# <br /> //f� �[ �MIT� <br /> LEGA LOT NO. � z � � <br /> DESC. BLOCK TRqC7 <br /> OWNER �T ' v� � / T� <br /> � � AUDRE55 <br /> ��//2/ ZIP PHONE <br /> 2��,� s,�.r� /yis ��,��G�r�xl�v� �zs-zs9-3/z3 <br /> TENAN7NAME <br /> CONTAC7 FOR PERMIT <br /> C PMONE <br /> �� Dl2lrfsAS�i.t� JT/�i/F ��Y/�—' �/ <br /> CONTRACTOR � 7�—LS�—Z� <br /> ��,� n ` ,) PUDRESS <br /> PHONE �� '��i�S�GN Z9��Q Z�P CONTR,LICENSE N <br /> /fEuJirT"�i'yl` y�Zp( .F�1YE�pM.SSAI�I <br /> PROPOSED USE OF BUILDING <br /> Building ��Aechanical <br /> ��//O� PERMI7 CombinaHon � Plumbin Addltlon HEqTSOURCE <br /> 7 �C{` TYPE Dernoliti0n 9 WORK �}(Alleratlon Electric <br /> Sign IYpE � New <br /> Sprinkler Gas <br /> CONTRqCT PR�CE OF WORK �9 Repair/Maint. OMer <br /> D• /�NJ) CITY OF EVERETT LOCA�gq�ES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> �U� uli�JiJow IP�.D �//�, C�c� �C-�;� . <br /> PLUMBING <br /> NO. TYpE OF FIXTURE OR ITEM MECHANICAL <br /> NO. TYpE OF FIXTURE OR IiEM <br /> _ WATER CLOSET(TOILET) <br /> _ BATHTUB � A/C—A/HANDLINGUNITS <br /> _ LAVATORY(WqSH BASIN) � FORCEG AIR SYSTEMS <br /> _ SHOWER __ HEATPUMP <br /> _ KITCHEN SINK&DISPOSAL _ UNIT HEATcRS <br /> _ DISHWASHER _ CLOTHES DRYER <br /> _ IAUNDRY TR,4Y __ RANGE HOOD <br /> _ CLOTHES WASHER WATER HEATER <br /> _ URINAL _ METAL FiREPLACE/STOVE <br /> _ DRINKING FOUNTAIN REPLACE INSE.4T <br /> _ FLOOR DRAIN GAS FIREPLACE <br /> _ BACKFLOW PREVENTER _, GAS R,4NGE <br /> _ SINK(SERVICE/BAR/MOP/ETC.) GAS PIPING ZE�t'q �'������ <br /> _, OTHER _ EXHAUSTFAN <br /> — -- _ OTHER <br /> �__ <br /> ---_ <br /> I FiEREBY C ITI THqT I HAVE READ qND EXAMINED THIS AP qND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIO� F WS AND ORIDINACES GOVERNING TH13.TYpE OF WORK•,VILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. TH N NG OF q pERMIT DOES NOT PRESUME TO GIVE AUTFiORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE O CA LAW REGULqTING CONSTRUC710N OR THE PERFORMANCE OF CONSTRUCTiON. THAT I qM AUTHORIZED BY TFiE <br /> OWNE F I PROPERTY TO PERFORM THE WORK FOR WIiICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT O 78.27 RCW AND 2g6.200 WAC. <br /> Si atur f 0 eNContractor/Authorized Agent � z/ O� <br /> i Date �/ <br /> DEBIT& CREDIT CARDS ARE NOT ACCEP7ED � <br />