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P�RMIT APPLICATIuN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> I -�- � -03 <br /> SITE ADDRESS 1 r PARCEL TAX I.D.# P �T x/ -G��J <br /> . D I' i'l � ? ,. <br /> i <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �v+9 �fir'��7�io�� So9Nte .�06-5/a - <br /> TENANT NAME CONTACT FpR PERMIT PNONE <br /> 127��1 c=ch4,�,•� ��,•� Uc��.����r- aoG��i- »�i � <br /> CONTRACTOR ADDRESS 21P CONTR.IICENSE p <br /> PHONE g��� /7�/�'�EGZ7� 77O�i <br /> �� -C"9�-s�so �'�'30 ��.-�.! �,� - �sn�oNow,.�st� <br /> PROPOSED USE OF BUILDING Buildi�g ��chanical Addilipn— HEAT SOURCE <br /> PERMI7 � Combination lumbing WORK ��tion D Eleciric <br /> TYPE DCmOliliOn Sign TYPE New U Gas <br /> Sprinkler RepairlMainl. U Other <br /> CONTRACT PRICE OF WORK -7- Q CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> / � n.�c (t>�(� /Zie�f'O <br /> WORK OE CRIPTION ' <br /> �� Ieru� l��JS�aI� Qa���ooN.t �17�Jv9�r �n NCw F✓�l ��; ��n (�Sev,o�� ti/ �,Sec�o✓S� P <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ,1� WATER CLOSET(TOILET) A/C-AlHANDLING UNlTS <br /> �� OATHTUB _ FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> = SHOWER — UNIT HEATERS I <br /> KITCH[N SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> ` CLOTHES WASHER METAL FIREPLACElSTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN G.4S FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK;SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> I OTHER S.•,..�,H� _ OTHER I <br /> — — — — � <br /> � — — I <br /> I HEREBI'CERITIFY THAT I HAVE REA�AND EXAh1INED THIS APPLICATION AND KNOW THE SAM11E TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF LAWS AND ORIDINACES GOVERNING T41S TYPE OF WORK WILL BE COAIPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERA-0IT DOES NOT PRESUA!E TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER i <br /> STATE OR LOCAL LAW REGUWTING CONSTRUCTION OR THE PERFORAfANCE OF CONSTRUCTION. THAT I Ah1 AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 78.27 R %AND .260 WAC. ! <br /> �' ,�.�`���� `��9��,� � <br /> � S�gnature of Owned ont ctorl u honzed Agent 7l�ate � <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED I <br />