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PEr2MIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> � <br /> SITE ADDRESS PARCEL TAX I.O.# PE iT x <br /> ,k�Ce,�le�r�1� ooy4Fsn33qo 2'1 ov C`��F��� � <br /> LEGAL �L1OT NO. BLOCK TRACT 1 I <br /> DESC. ,L� '� 2 $ 3 3 ��\�l. �,..'��Q.1 ' <br /> OWNER AO�RE55 ZIP PHONE <br /> �e��r4 5 So IZ �c v� I�aIZ �Zoc.F:A ��ler /�de. �=Je.rvH— 9 �s Zo l- 25C'42. <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> � CSf2� L\hJ1I �'C.. ;zO�o— ��0 �.3�75 _ I <br /> CONTRACTOR ADDRE55 ZIP CONTR.LICENSE# II <br /> o��neX' �� ��, "Ro c,ke�U�er R v� <br /> PHON y�1T'_�S�— 'iZ.Z S` I <br /> PROPOSED USE OF BUILDING Building D Mech.:nical Atldition HEA7 SOURCE ', <br /> PERMIT Combinalion U Plumbing WORK �Alteration � ElecMc i <br /> TYPE Demolition U Sign TYPE New Gas <br /> Sprinkler RepairlMainL Other I <br /> CONTRACT PRICE OF WORK �k �5 f� CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 I <br /> v <br /> WORK DESCRIPTION <br /> '�Lk �� �ac-k yard <br /> syy�q �� o«�,:�, <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) __ A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATOFY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RAhGE HOOC I <br />_ LAUNDRY TRAY _ WATER HEATER I <br /> I CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT I <br /> DRINKING �OUNTAIN __ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE I <br /> BACKFLOW pREVENTER _ GAS PIPING I <br /> SINK(SERVICE/BARIMOPIETC.) __ EXHAUST FAN <br /> OTHER _ OTHER � <br /> I — — I <br /> i — � <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXA�IINED THIS APPLICATION AND KNOW THE SAM1tE TO BE TRUE AND CORRECT. ALL I <br /> ' PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED W ITH WHETHcR SPECIFIED HEREIN OR I <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM1IE TO GIVE AUTHORITY TO VIOW7E OR CANCEL THE PROVISION OF ANY OTHER I <br /> � STATE OR LOCAL LAW REGUUITING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> �' OWNER OF THIS PROPERTY TO FERFORAI THE WORK FOR N'HICH APPLICATION IS A1ADE AND I COAIPLV WITH THE STATE <br /> CONTRACTORS LAIN 18.27 RC1V AND 296.200 WAC. � <br /> ����`7�-_ y/z y/�� � <br /> gn tur �vner/Contractor/Authonzed Agent �� � <br /> ; DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />