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PERMIT APPLICATION ; <br /> CITY OF EVERETT PERMIT SERVICES j <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-88F7 <br /> SITE ADDRESS PARCEL TAX I.D.# �R U����D ZO I' <br /> j�� 7(c � /��eL. � VG . <br /> LEGAL LOTNO. BLOCK TRACT ' <br /> DESC. <br /> OWNER ADDRESS ZIP PMONE I <br /> ,Qr�tf' a-,��i n.ci L..J/i. ��- 3G Z4 LL�/M..L/a v� 97�i�3 I <br /> TENANT NAME CONTACT FOR PER T PHONE <br /> � �.:_�.-�i/�.� , /� zn� 9r�-,zo�,U <br /> CONTRACTOR ADDRESS � n ZIP CONTR.LICENSE 7! I <br /> �ic._�nonoL �.n�.�ry .Z.�-�j aW s�'� � /INfcil fl�OSS" ?�1.4�c�,elnl.zd I <br /> J <br /> PHONE I <br /> ,ZOG• - 9i�-zoG•n <br /> PROPOSED USE OF BUILDING I7 Building f'1 Mechanical Atldition I HEAT SOURCE II <br /> PERMIT �_� Combination E_l Plumhing WORK Alteration Q Electnc <br /> ���' TYPE �( Demolilion LJ Sign TYPE New I �..,/ Gas I <br /> L) Sprinkler RepainMaim. U Other � <br /> CONTRACT PRICE OF WORK��fn �7J CIN OF EVERETT LOCAL SALES TAX COOE IS 7105 II <br /> T— <br /> � <br /> WORK DESCRIPTION / �� / , i <br /> I n � 777 i ri Ft� ' <br /> /f.�_rlL�✓'�— �Ll�/ST//�q l-001- I�'-c�I2CG !�� / Lt� /�")c`- i <br /> I J <br /> n / ! <br /> �<�ni : ��tM n��.r�� �/ye�cnC� R.S n�iv�%c�. <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) _ I�EAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACEiSTOVE <br /> I URINAL FIREPLACE INSERT <br /> �� DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOGR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING ��. <br /> I SINK(SERVICEiBAR/A10P/ETC.) _ EXHAUST FAN <br /> � _ OTHER _ OTHER I <br /> I — — ; <br /> � — <br /> I HEREBY CERITIFV THAT I HAVE READ AND EXAM1IWED THIS APP!ICA710N AND KNO'.V TNE SAME?O BE TRUc AND CORRECT. ALL <br /> � PROVISIONS OF L4WS AND ORIDU�.4:.ES GOVERNING THIS TY°c QF WORK WILL BE CO\1PUED 1VITH N'HETHER SPECIFIED HcREiN OR <br /> NOT. THE GRANTING OF A PERM1IIT DOES NOT PRESUME TO GI��E AUTHORITV TO VIC!ATE OR CANCEL THE PROVISION CF AIJY OTH'cR <br /> STATE OR L WW REGULATING CONSTRUCTION OR?HE PERFORI�1ANCE OF CONSTRUCTION. THAT I Aht AUTHORIZED BY THE <br /> . OWNER THI PROPERTY TO P� FORM THE WORK rOR 1VHICH,IPPLICATION IS MADE AND I COMPLY IVITH THc STATE �� <br /> CONTR CTORS bV 1827 RCW N 296.�00 WAC. � 'i <br /> �, ' ��� ��/�G /'Y I <br /> '. Signalure of OwnedConlractouAu�honzed A9ent Date � <br /> DEBIT & CREDIT CARDS A�.E NOT ACCEPTED <br />