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r <br /> � <br /> ��I�I�IIT ApPLICATlON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE T, EVER�TT, VVA 9820� <br /> 425-257-8810- FAX 425-257-8357 <br /> �� b� ' -��/ <br /> SITE f\DDRESS PARCEL TAX I.D.# �ERh11T:: � <br /> 1 '� 3K-�P� �'Jl''+R- �d�.---_f��� � c3�sao-�Ob o5� - oi N 406 — a9 <br /> _EGPLi LOT NO. � BLOCIC TRACT <br /> .=�C � �_,,,p pl- o3-2. � �- � <br /> OINNER —Q ADDRESS �IP PHONE <br /> �-cQa�2�-�c�,�-w-�l2�s es L4.t_ l�i o�v a-3 5��� e 5 L- P�'4'��- `i SSU t?. 4�s Z�k3 <br /> TENANT NAh1E CONTACT FOR PERMIT PHOME ��1� � <br /> � ��w) ��S.S�� �a-�J — �L�`1i'�L� �g — . <br /> CONTRACTOR ADDRESS ZIP CONTR. LICENSE# <br /> (-��a.�2E�lL-4e-� �JR.ts�.�� �-�-e- �'loT�a•3s�F}aeSE 4'�oihn9zg5n���- A9f1-Te�w3�c� <br /> PHONE I <br /> PROPOSE�USE OF E3UILOING (YBuilding �techanical �;:iticn HEAT SOURCE ' <br /> S`�4 �,� �a,�� PERMIT i�Combination �lum6ing WORK Aler„tion (� Flectric �, <br /> ,,.� ,,^ �,, ivpE � D�molilion Sign 7vPE ew ��'Gas ! <br /> ,��x Sprinkler RepairiMaint Other <br /> COtlTRACT FRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> `P/0ftK DESCRIPTION ' <br /> t�� ������. -��� -�-�k t3,.ax.� -� aas�{ <br /> PLUMBING MECHANiCAL <br /> NO. I TYPE OF FIXTURB OR ITEM NO. TYPE OF FIXTURE OR ITEM -- � <br /> -T WATER CLOSET(TOIi_=T) A/C-A'tiAN�LING UNITS I <br /> � BATHTUB _(_ FORCED AIR SYSTEh1S <br /> � LAVATORY(WASH BASIN) _ HEAT PUn�? � <br /> SHOWER UNIT HEATERS <br /> _� KITCHE�SINK 8 �ISPOSAL _�_ CLOTHES DP.YGR � <br /> �_ DISHWASHER RANGE HOOD <br /> LAUNORY TRAY _j_ WATER HEATER <br /> � CLOTNES WASHER _ M1�IETAL FIREPLACEISTOVE <br /> URIIJAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN _j_ GAS FIRGPLACE <br /> FLOOR DRAIN GAS RANGE j <br /> BACKFLOW PREVENTER < GAS PIFINv , <br /> SINK 1>ERVICE�BAR/MOP/ETC.) � BXHAUST FA�' ; <br /> ---, OTHER_ _ OTHER <br /> — i <br /> —� — � <br /> � I <br /> I I <br /> -��REdY CERITIFY i HAT I HAVE READ AND EnA�.111JE0 THIS APPLICATION AN�KNOLV THr SAIviE TO[3E TRUE AND CORRECT. i+LL I <br /> �-RGVISiONS OF(.AWS AND JRIDINACES GOVERNING'i HIS TYPc OF WORK 1VILL BE COIvIPLIED 1VITH IVHETMER SPECIFlED HEREIN CR <br /> '10 i. -tiE GRANTING OF A PERh11T DOES NOT PRESUGiE TO GNE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF i.NY OTHER � <br /> -,;TE OR!OC?1�.::N REGULdTING CONSTRIICTION OR THE�ERPORMANCE OF CCNSTRUCTION. 7HAT�Ahi AUl'HOR2ED 6Y?HE <br /> ...�.-.. : '!'�IS ,;GsJPER"i TO 'ERFORI.1-iiE`�VORK"rOR1VhICHAPPLiCATIONiS'.1ACE.�IJDIC061PL�^:;'ITH iHES�.•TE <br /> -. " „T��ii.`- .. ��._i GC:V,::D�9u-.�.00AVAC. <br /> ��,_?.t�^ (�1 a�sloy <br /> ti�r'�^�:t�:.�V .r �. �.::�:,, �'ontr;r ri4 •lhorzi:d: �en: Dale �� <br /> D�3!T & CR�CIT CARDS ,aRE t�IOT ACCEPTED <br />