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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS n � PARCEL TAX I.D.if FRMI <br /> 7 7 0 � 'r �- I\ 0 0 39 Z 6 D o 00 0 4oD � U�a.�-� � <br /> LEGAL LOT NO, BLOCK TftACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> N�^�Y . , . �, . Na�ih��.i 77o I iy� 2a 9�Zo3 yu-�3�ys6 <br /> �trvArvi rvAME c�, /I'I_/�/ 1 CONTACT FOR PERMI7 PNONF. <br /> ���� C�.b h/ <br /> I Ro9a� A���-�qd yZs -3ss . o7V3 <br /> CONTRACTOR �I n� f �,/� 1 ` ADDRESS l' 1 / ZIP CONTR.LICENSE p <br /> �6� QdNt_ ICG'Ci1v�{'� Tl.v..N/�[.+�i1 �ZUS Y� 'P AVI. SG <br /> PHONE��.S 3ss-o� v3J E„r.,�-�� �'P 9gZ,°S 2o�k2C,;000Phl <br /> PROPOSED USE OF BUILDING I Building MeChaniCal Addition HEAT SOURCE <br /> � � PERMI7 � Combination � Plumbing IWORK � Alleration A � Eleclnc <br /> t�pp TYPE Demolilion Sign TYPE New �/ Gas <br /> � Sprinkler Repair/Maint. / Other <br /> CONTRACT PRICE OF WORK �t 3 I OD ,D 0 � I� CIN OF EVERETT LOCAL SALES TAX CODE IS J7Q5 <br /> WORKDESCRIPTION � \ <br /> ;,.5��.►� � � ,3�' c��p�ry ,4'� �„q�,..�,J sr°�..;�� 0.a��� <br /> U <br /> I <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 AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY'(RAY 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 /> I — — <br /> I HEREBY CERITIFY THAT I HAVE READ AND E,KAMINED THIS APPLICATION AND KNOW THE SAA1E TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF LAWS AND ORIDINACES GOVERNING i HIS TVPE OF WORK WILL BE COA7PLIE0�NITH WhiETHER SPECIFIED HEREIN OR <br /> �i N07. THE GRANTING OF A PERM17IT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEI_THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATIkG CONSTRUCTION OR THE PERFORMANCE OF CONSiRUCTION. TiiAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN?O PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I CO�iPLY WITH THE STATE <br /> CONTRACT RS LAIN 18.27 RCW AND 296.200 WAC. <br /> I z.� � y n,ti, o V <br /> Signawre of OwnedContracrodAuthunzed Agent Dale �d <br /> i DEBIT& CREDIT CARDS ARE NOT ACCCPTED <br />