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�— � � -- <br /> 't'ERMIT A.PPLICAI'�ON <br /> CITY OF EVERET7 PERMIT SERVICES <br /> 3200 CEDAR Sl'REET, EVERETT, WA 98201 i <br /> 425-257-8810- FAX 425-257-8857 I <br /> � <br /> SITE ADDRESS �/7� PARCEL TAX I.D.# PERMiT tt <br /> � ' .�', .sw� sr S -��no-aa - ov �3i� - c s�- <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. I <br /> OWNER ADDRESS ZIP PHONE I <br /> T/�/ �3=��.�D ii�a.3 �-��9�� sE 9���'s- .3s-s c9�/ � <br /> TENANT NAME CONTACT FOR PEf2MlT PHONE <br /> /�i�'iC G n�e y,�s-��y-9�� z. <br /> CONTRACTOk�j��jTJj s�i�,ST(�'q.-.f�ar� ADDRESS �� dCh 3rJ� c� ZIP CONTR.LICENSE# <br /> /�1.�� <br /> PHONE <br /> ��,�5�.��/-9� 6 Z, tiv�T/G /� Lo <br /> PROPOSED USE OF BUIL�ING uildi�g n Mechanical Addiliin HEAT SOURCE <br /> 5 '��vL� ���,n��Y PERMIT Combinalion n Plumbing WORK Aitera:on [� Eiecfnc <br /> IYPE DCm0lilion � Sign TYPE New U Gas <br /> r��s��r �, �� Sprinklef Repair/Maint. UOther <br /> I�- �IU <br /> CONTRACT PRICE OF WORK /�/s-� p '�� ����_7 CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> !/ / <br /> WORK DESCRIPTION � ' <br /> � C(,,t ci�� <br /> n <br /> L '.�� .7� .S l'v/' ��.?�D'''c <br /> �YL�1'4,C> <br /> P�UMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) __ A/C-rVHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP � <br /> SHOWER UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL C � � — RA�NGE HOOD ER <br /> �ISHWASHER �9 — <br /> � _ LAUNDRY i RAY N _ VJATER HEATER <br /> CLOTHES WASHFR METAL FIREPLACE/STOVE <br /> ' URINAL FIREPLACE INSERT <br /> I _ DRINKIIJG FOUNTAIN � GAS FIREPLACE <br /> � FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> � SINK(SERVICEIBAR/MOP/ETC.) � EXHAUST FAN <br /> I, OTHER_ _ OTHER <br /> �i — � C <br /> ' I HEREBY CERITIFY THAT I HAVE READ AND EKAMINED THIS APPLICATION AND KNO1V?HE SAA"E TO BE TRUE AND CORHECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS.TIPE OF 6VORK 1VILL BE COM1iPUED N'ITH 6YHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUM1IE TO GIVE AUTHORITI'TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � SiATE OR LOCAL L1W REGULATING CONSTRUCT;ON OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 9Y THE <br /> OWNER OF THIS PROPERN TO PERFOR�d THE WORK rOR IVHICH APPLICATION IS IdADE AND I COMPLY WITH THE STATE <br /> � CONTRACTORS LAW 18.27 RCYV�A�N .90.200 WAC. <br /> �,���1 -�r"•�-- <br /> I Signature of OwneuContractorlAuthonzed Agent Oate �/? <br /> DEBIT 8 GREDIT CARDS ARE NOT ACCEPTED <br />