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-� <br /> PERMIT APPLICATION I <br /> � C;iTY OF EVERETT PERPJIIT SERVICES <br /> 32uv CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810 – FAX 425-257-8857 i <br /> SITE ADDRESS PARCE..TAX I.D.# P�RMiI _ <br /> � c�� �. 'JiCi�(�o�'� pPJ�C cvn�,4- noo-o52 -voo7 � _ � - 0�� � '� <br /> LEGAL LOTNO. BLOCK TRACT I <br /> ; oesc. 5.•'., /��) i2 � ��� ,c /�i�� l�i V '4' VGL iL P6. i �i c. <br /> � OWNER ADDRESS ZIP PHONE <br /> L(%IJA�'� i �tr�GH/��'Y Na�'F�: q�`1 �%,V�E��I�OG-�� DIZ•, GJEP-GTT; b�l�, �Q�7�'> <br /> T[NANT NAME CONTACT FOR PERMIT HONE <br /> ,��� U�-���w.� P u r-� ��2�) ��� �3� I I <br /> CONTRACTOR AD�RESS ZIP CONTR.LICENSE# I <br /> -�uh�M Hi1�� Pt�lti `lr�l- `i � %j, NuKII:T-t(;v, I,yt: �uh�ivt-� P�44i��- � <br /> PHONE C` '�IIt1 C� I-IJfIA}� � �"��l?i I:/ I% 1�`,4' I <br /> J�17��� �i31�U�9`1 �� Y <br /> PROPOS[D USE OF BUILOING 68 Building D Mechanical I AAdition HEAT SOURCE <br /> �� r� PERMIT �� Combination U Plumbing WORK � Alteratior� � Electric I <br /> " TYPE �l Demolition U Sign NPE New Gas <br /> L� Sprinkler RepairiMaine Otner <br /> CONTRAC(PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> WORKJEaCRIPTION �� I �� I���`-7 H�D���(/N I v �'1 �`� I����I�p�K� IY'�-' <br /> z r3eo�x:ri��, 2 i�Tl�RrxxM��, t-l�uN ���Y iv/p, <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. IYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) NC—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(�"/ASH BASIN) _ YEAT PUIdP <br /> ' SHOWER UNITHEATERS <br /> KIl�CHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> DISHWAFHER � RANGE HOOD <br /> � _ LAUNDRYTRAY _ WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> ' URINAL FIREPLACE INSERT <br /> i DRINKING FOUNTAIN GAS FIREPLACE <br /> � FLOOR DRAIN GAS RANGE <br /> I BACKFLOW PREVENTER GAS PIPING <br /> I SINK(SERVICE/BAR/MOPIETC.) �_ EKHAUST FAN <br /> '� OTHER OTHER <br /> I HEREBY CERITIFV THAT I HAVE READ AND EX4MINED ;HIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISI(' �'OF LAWS AND ORIDINAC�S GOVERNING THIS TYPF OF WORK WILL�E COMPLIED N'ITN WNETHER SPECIFIED HEREW OR <br /> � NOT. Tf.. �RANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STpTE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFURMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE I <br /> OWNER OF THIS PROPERTY TO PERFORM THE INORK FOR VJHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE I <br /> CON ACTORS LAW 18.27 RCW AND 96.200 WAC. <br /> � � :���z� �, _� �� �"IZ-`� �I <br /> I Si nature of OwnenContractodAut onzed A ent Date <br /> 9 � DEBIT & CREDIT CARDS ARE NOT ACCEPTED /� <br /> �— – <br />