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- ' . <br /> PERMIT APPLICATIG��I <br /> CITY OF EVERETT PERMIT SERVIGES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT a <br /> �1/3 /�o�/,- /-:�l�irA�e Mo3i�-o3 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE /UZS <br /> (p ry,ii ,�Ju fh / S�/3 (f'a�/lh 'h'�(�. +�✓� 9b'Za� �Z3Z•S38 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �UfyN <br /> • T,��f'� �yz.f� 132- > 3 X�8 <br /> CONTRACTO � � ADDRESS ZIP CON7R.LICENSE N <br /> WqSh��y�n W�i�� a �s ,���.. 8�iy �1L, D� n/E �iy��v <br /> PHONI �� Q� �5 J � Y 2 I (N � / S/! I / �1 / �L/�/ <br /> PROPOSED USE OF BUILDING Buildiflg {� Mechanical � Additlon HEAT SOURCE <br /> PERMIT B Combinati0n �`} plumbing WORK Aileration � Electric <br /> TYPE D Demalition � Sign TYPE New Gxs <br /> U Spfinklef RepaidMaint ONer <br /> CONTRACT PRICE OF WORK �� CITY OF EVERETT LOCAL SALES TAX CODE IS 9705 <br /> WORK DESCRIPTION �� 2 �� / r �j � <br /> J'P <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FU(TURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—AIHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYEN <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY �C WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAU5T FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPIICATION AND KNOW THE SAM:TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMP�IED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL�W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THI PR PERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT:� 18.27 G1NJIND 296.200 WAC. <br /> %:� �.� �`- �JV� <br /> Si ature of wnedContractodAuthorized Agent Date <br /> DEBIT& CREDIT CARDS ARE NOT�►CCEPTED <br />