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� 'f�ERMIT APPLICAT�ON <br /> GETY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-2F7-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 75 2. ?"�= +Poqa o0 3 2cmoc^,�_ �Q31 D -(J l9 <br /> LEGA LOl"NO. BLOCK TRA,CT n ' r <br /> DES0. � — si� �X �� � C?34� <br /> OWNER AD�RESS ZIP PHONE <br /> �-�N ���� ��L .Po. fSor i36�/7 n�i� [�� 9�0�2 7�1'v-y9B- Z�'i <br /> TENAN"iNAME CONTA�TFURPERMIT PNONE <br /> N��4 I -S�,�n/ /YIRSorV �.vv -Y98- ZB96 <br /> CONJ$ACTOR_ � Q���� ADDRESS ZIP CONTR.LICENSEN I <br /> �f�/��� <br /> PHONE MAsoh/�`. 9�v A2 <br /> Z�lo- y98 �ZS�Tb <br /> PROPOSED USE Of BUILDING Building D MOchanical Additicn HEATSOURCE <br /> ' � PERMIT � C�mbination u Pl9mbing IWORK � AltPration I � ElecUic <br /> �/�LF �Mvl. TYPE Demolilion U Si n 7vpe New �as <br /> S nnkler Re air/Maint. Olh:r <br /> CONTRACT PRICE OF WORK //��� I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION • <br /> �ns�-�,��vn o'� h-�J {S78 5� � S,�;R, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB = FORCED.\IRSYSTEMS <br /> LAVATORY(WASH BASIN) H[AT PUP�1P <br /> � SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 OISPOSAL � CLOTHES DRYER <br /> � DISHWASHER RANGE HOOD <br /> O LAUNDRY TR4Y _L WATER HEATER <br /> Z CLOTHES WASHER METAL FIREPLACE/STOVE <br /> D URINAL FIREPLACE INSERT <br /> I � DRINKING FOUNTAIN Z GAS FIREPLACE <br /> � O FLOOR DRAIN � GAS RANGE <br /> � BACKFLOW PREVENTER GAS PIP�NG <br /> � SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBV CERITIFY THAT I HAVE READ AND EW+MINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND I:ORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPEi.IFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMI7 DOES NOT PRESUdAE TO GIVE AUTHORIN TO VIOLATE OR CANCEI.THE PROVISION OF ANY OTHER <br /> i STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZE�BY THE <br /> iOWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT LAW 1827 RCW AND 296.200 WAC. <br /> ��12--� /D /�1�03 <br /> I Signature of OwnedContractodAuthonzed Agent Date � � <br /> 1, % <br /> � DEBIT& CREDlT CARDS ARE NOT ACCEPTED <br /> � <br />