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i <br /> � 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 /> SIT ADDRESS pZC7� C��Or1 C.1� PARCEL TAX I.D.# PERMiT K <br /> ��c � . ��P.c.�etl�✓/�I �0 3q a o0 0 0 �o a � Uo�1- oo�l I <br /> LEGAL LOTNO. /� BLOCH TRA G -}� �� I <br /> DESC.� / � ��� �� D �l9���eei- o'�' �`� " . . <br /> OWN R ADDRESS ZIP PHONE <br /> ��n as'f��•.�iN ���e✓' %S o �h��S� � 9�clo`7 /-S`I�-3sv� . <br /> �ANT�E.r7 /_ C TACT FOR�r ER IT PHONE ��2� <br /> � t !'�e.CJec-�� �✓✓,esl cilpv� /-S°t(-3� <br /> � (' e ✓' <br /> CONTRACTOR � /� 6'�G r ADDRESS �F�'j- �N Z�P W�L�'i�G G9S 6D a <br /> /J� � �SS <br /> PHONE /o��p --�v��3 � I <br /> PROPOSED USE OF BUILDING Building fl MCchaniCal Addition 4EAT SOURCE� <br /> PERMIT R COmbinali0n f-y Plumbing WORK Altereiion ❑lectnc I <br /> w �� � (' � � 4� �' �� irPE B Demolition LJ Sign Tl'PE New �Gas <br /> g�� �� Q�� Sprinkler Repair�Maint. O�her <br /> CONTRACT PRICE OF WORK Z�c�/ pUrJ � � / CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 II <br /> / ,/.., ' <br /> WORKD SCRIPTION j7C�"1mUQ. Q'V'(uG q / I�E,\Ql PY� "'�4�� / ''�fuC CG ,� <br /> w� �e�-�����o���mov� �`-� �. J '�p (``�e cvNr �e <br /> � � <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> WATER CLOSET(TOILET) _ A/C—lVHANDLING UNITS <br /> BATHTUB . FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP � <br /> SHOWER _ UNITHEATERS �I <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY _ WATER HEATER � <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE I <br /> URINAL FIREPLACE INSERT � <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SFRVICEiBAR/M190P/ETC.) _ EXHAUST FAN <br /> _ OTHEF_ _ OTHER I <br /> — i <br /> i I <br /> � — <br /> ' I HEREBY CERITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAM11E TO BE TRUE AND CORRECT. .4LL � <br /> � PROVISIONS OF WWS AND ORIDINACES GOVERNING THIS TYPE OF IVORK IVILL BE COM1IPUED WITH WHETHEft SPECIFl�D HEREIN OR <br /> � NOT. THE GRANTIKG OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAN'REC�UWTING CONSTRUCTION OR THE PCRFORM1I4NCE OF CONSTRUCTION. THAT I AA1 AUTHORIZED BY THE I <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS M11ADE AND I COM1IPLY WITH THE STATE <br /> CONTRAC ORS LA V 27 RC1N AND"<96200 6VAC. � <br /> __�2,_:���,�Q� `f - / � �`�" � <br /> Sign ture of wner/Cor tracror/Authonzetl Agent Date �L <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> oy� G�� � G <br />