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�t-a3 -c `3 �1 <br /> � r'ERMIT APPLICAI iON <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810— FAX 425-257-8857 I <br /> SITE ADDRESS PARCEL TAX I.D.# PER iT z ' <br /> ��iZ2:%/Z � <br /> - - - � <br /> LEGAL LOTNO. BLOCK TRACT � <br /> DESC. <br /> OWNER AD�O/O�' �ST //�lVC SP� PHONE� 06 3�2�ry?2 <br /> Y <br /> �Pti�IQ i�—� � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ii <br /> , ;�� , �F���� ,,��,y ,�{,�_�a -� <br /> CONTRACI'OR ''/ ' ADDRESS � l ZIP CONTR.LICENSE# /�I� " <br /> PHONE ���C�v� Cy��VE!?yL C�-6�1�/lC���i L'��C/V �G-�/ 7iZ-(7/'I <br /> -- � � <br /> PROPOSED USE OF BUILDR�G BUilding � Mechanical Addition HEAT SOURCE <br /> , PERMIT � COmbin3ti0n Plumbing WORK R Alteratlon D ElecVic 'I <br /> Siidv�:+ Fnn+l�Y (Z85�d` TypE Demolilion si9n NPE �� New U Gas <br /> Sprinkler pc(� Repair/Mainc U Other <br /> CONTRACT PRICE OF WORK CIN OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> WORK�ESCRIPTION � <br /> .V�v �il.'fCG S . �i4Tfl.4 o�M M�v�.�JL�f . <br /> P.l'I ��2 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. T:PE 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 8 DISPOSAL L._ CLOTHES DRYER <br /> DISHWASHER 7 RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> _� CLOTHES WASHER _ METAL FIREPLACE�STOVE ' <br /> URIN�.� FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> , SINK(SERVICE/BARlMOPlETC.) � EXHAUST FAN <br /> I OTHER _ OTHER <br /> � <br /> I — - � <br /> � I HEREBV CERITIFY THAT I HAVE READ AND EXAI9WED THIS APPLICATION AN�KNOW THE SAIdE TO BE TRUE AND CORRECT. ALL <br /> . PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS�YPE OF WORK 6VILL BE COMPLIED\NITH LVHETHER SPEGfIED HEREIN OR I <br /> NOT. THE GRANTING OF A PERh11T DOES NOT PRESUME TO CIVE AUTHQRI iY TO VIOLITE OR CANCEL THE PROVISION OP ANY OTHER <br /> . STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 9Y THE I <br /> '� OVJNER OF THIS PROPERN TO PERFORAI THE IVORK FOR WHICH APPLICATION IS MAOE AND I COAIPLY WITH THE STATE i <br /> � CONTRACTORS LAW 18.27 RCW AND 296.�00 VVAC. I <br /> i <br /> • — O <br /> I Signat e of 0 EUCon ractorl u o i e Agent Date , <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED /�> I <br />