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- 1 <br /> � <br /> PERMIT �4PPLICATIUN I <br /> CITY OF EVERETT PERMIT SERVlCES ' <br /> 37_00 CEDAR STREET, EVEREl"r, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 i <br /> le -o �o3 I <br /> SITE ADDRESS PAkCEL TAX I.D.# PERMIT� ��, <br /> i' � <br /> � �E;25 �`1^ �G �cR� Do3qz6000c�3oo `. _ ; ,_�-; , <br /> LEGA LOTNO. BLOCK TRACT – I, <br /> DESC. <br /> OWNER �Nn�p � ��`Lv,J A�DRESS ZIP PHONC^�� <br /> ��-iis- 43�. - 'L'Az��~ <br /> IZf�Vrv'�t7 QH�`L�., �6L `_� Tyi-i PGRO IfzZ�3 4LS— LZ— �c.L? � <br /> TENANT NAMF. `CONT T FOR P RMIT PHONE I <br /> ` , / <br /> �i'Itt� r}�::�I50•v' ,1����'N�.� ��.C�.,G�1�� � �jt�i7 <br /> ��w.�: J L.ti .C��+K�C <br /> I CONTRACTOR U� ��,L ADDRESS ZIP CONTR.LICENSE# <br /> I <br /> PHONE <br /> �t7-i .' 4'�e, "z`(1 5 <br /> I PROPOSED USE OF�UILDING Building D Mechanic�il AdJition HEAT SOURCE <br /> PERMIT Combinafi0n u Plumbing IWORK Alteration �lectnc <br /> II �uS�J�� 1` �„�;���;: TYpE Demolilion U Sign NPE New Gas <br /> �, ` ���r Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK , ,� _ CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> � � <br /> I WORK DESCRIPTION � . <br /> Ii , . ,' , , � ' , . __ <br /> �1j,DLTZoN , <br /> / ! MECHANICAL <br /> PLUMRING <br /> ��� NO. TYPE OF FIXTURP OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> + WATERCLOSET(TOILET) I�/ NC–AIHANDLI�GUNITS <br /> ��� BATHTUB /I/ _J_ FORCED AIR SYSTEMS <br /> :y i{I L,aVATORY,(WASH BASih) /�f _ HEAT PUMP <br /> L I SHOWER // UNITHEATERS <br /> � _� KITCHEN SINK&DISPOSAL � CLOTHES DRYER <br /> � _i DISHWASHER RANGE HOOD <br /> � y_ LAUNDRY TRAY I WATER HEATER <br /> �._ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIRC-PLACE <br /> � _ FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER � GAS PIPING <br /> SINK(SERVICE/BAR/MOPlETC.) �_ EXHAUST FAN ��I � <br /> OTHER OTHER <br /> — i <br /> -- I <br /> � ��REBY CERITIFY THAT I HAVE READ AND EW+MINED THiS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL I <br /> I-RGVISIONS OF LI+VJS AND ORIDINACES GObERNING THIS TYPE OF WORK WILL BE COAtPLIED WITH WHETHER SPECIFIE�HEREIN OR <br /> !;OT. THE GRANTIIJG OF A PERMIT DOES NOT PRESUME TU GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIOIJ OF ANY UTHER <br /> STATE OR L(.::AL'✓4.7 REGULATING CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 81'THE <br /> ;)':':'cR OF TH'S PROPERN TO PERFORM THE WORK FOR WHiGi APPLiCATION IS A7ADE AND I COMPLY WITH THE STATE I <br /> ;;:;'1TRkC-G°�5'.i.7: 1 P,.27 RC W AND 296.200 b'✓AC. I <br /> �,,•�Ge-v�.� 9/L/o3 <br /> ,�gnature.`.vm�:cCoraractorlAuthonzed Agent Dale �/ <br /> l Z i <br /> DEBIT � CREDIT CARDS ARE NOT ACCEPTED <br />