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{ PERMIT APPLICA`'i lON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRE55 PARCEL TAl(I.D.8 PERA9IT# <br /> -i S � �f %Y c� /�c7.9-i7 K,o 3 C�S-G!Y 8- <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS 21P PHONE <br /> SC�9r. /9"�ASUti <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS <br /> �U/.S/NSv� ���in(r . /.�-c. � . ZIP CONTR.LICENSE# <br /> PHONE �?G.>v�Y�3 - tiYC� Z a-9� 3o /Z..r,-�� A�_� ,�-c' � 1��3itiP.i-z� zc <br /> .II:�LitiGlr��. �2�'i <br /> PROPOSED USE OF BUILDING I � Buildinc� D Mechanical Addilion HEAT SOURCE <br /> PERMIT Combination U PIUrtlbi�g IWORK � Alle2�lon � EletUic <br /> S �=7� 7YPE DemdifiOn U Sign TYPE New Gas <br /> Sprinkler RepairlMainl. Olher <br /> CONTRACT PRICE OF WORK �� �U� CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> WORK DESCRIPTION <br /> /n,51Ytc� /-i iL< <; �.2 ..�i�c L'7� S�'S2'�z <br /> � i.v <br /> ....L-"l� S�2 <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE 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& DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> LAUNORY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER OTHER <br /> — /� N�],�S <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAM1IINED THIS APPLICATION AND KNOW THE Sl,ME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF La6YS AND ORIDINACES GOVERNING TNIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GFLINTING OF A PERMIT DOES N0T PRESUh1E TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OP ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PEFFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OVJNER OF THIS PROPERTY TO PERFORh1 THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 R A D 296.200 WAC. . <br /> � �� � S�i��� 3 <br /> Signature of OwnedContraclor/Authonzed Agent Date r-- <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED `/Z <br />