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r--- <br /> .. <br /> P tRMIT APP1LICA W P N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.U.# 1 PERMIT# <br /> 1.-/50 EV au„ \--1,,-1 I Ci v S5 o7 011 O- , $O 103C) <br /> LEGAL1 LOT NO. BLOCK TRACT <br /> DESC.f i Z <br /> OWNER ADDRESS ZIP PHONE <br /> U of>fu`7 krts5 i�r► .3—p,CA.)133V/J 95-0 U 4) EVt)tGrtev-a (",n 1 —1 l 20 3 (92s-).as-) '01,30 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR A D.6 co z-.,r L ADDRESS pa nu, 1 is ZIP CONTR.LICENSE# <br /> 0 PHONE <br /> Sr-k..)17101,._L'I( '-.z5v, VA 9 GaS t -I as s J\UDC .)1. 1..21 Lc <br /> t PROPOSED USE OF BUILDING uildingMechanical Addition HEAT SOI,RCE <br /> PERMIT Combination Plumbing WORK Alteration Electric <br /> TYPE Demolition Sign TYPE New Gat <br /> 1o�s�L Sprinkler Repair/Mlint. Othe. <br /> CONTRACT PRICE OF WORK / - ,- I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> 1a c"Y'Ln(.,: (L-Nt Tsric. 12-+:"VA=.1c. t-4,,4. <br /> mac Imo, I.L - tV...)f Zo �uT .1"{T flnc.r� FA -% &�rzlsufc w.�� _ <br /> A Do rib.-, tacT,nr-. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO.. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) AIC--A/HANDLING UNITS <br /> BATHTUBFORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT F'UMP <br /> SHOWER UNIT HEATERS <br /> __ KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> __ DISHWASHER RAN(:E HOOD <br /> __ LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINALFIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACI: <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> J I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE CR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR L eAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER THIS PR •-- TO Pr-FORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONE ACTORS • 18.27 R' • AND 296.200 WAC. <br /> _ <br /> --.11.-- -/f- OS <br /> Si ur s •wner/Contractor/Authorized Agent Date 011a <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />