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; � <br /> PtRMIT APPLICATIC)N <br /> ClTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9820� <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDR ES' PARCEL TAJ(I.D.# I PF�RMI7#, I �� <br /> ,30// (/i�ODL �l. N��i.�U �5 <br /> 1 <br /> ��.EGA LOT NO. BLOCK TRACT <br /> DESC. <br /> �O NER ���� (/ °�;oe� 6�l L�Jy�ri�, r.��t Z�P"/o�'�^���-O NOC <br /> �c� / ����5 <br /> TENANTNAME CONTACTFORPERM T PHONE <br /> �f�u/����1�,1-s � ���r/>>��v���s ���-3i7-g��a <br /> CONTRACTOR "' �l � �`y���sADDRESS�j�� w2 _,x�/�� ZIP CONTR.LICENSE# p �y <br /> �li� �-/ C�../�/Gbl�� C '���'/�9�i+�/8//�`/ <br /> PHONE "/�� �c..��.1 �' 'J� 3-I �./J/�JiJL�I����I !�� <br /> PROPOSED USE OF BUILUING �> Building 13� Mechanical n Addition HEAT SOURCE <br /> PERMIT ���� Combination Y� Plumbing WORK �-� AlteraUon Q ElecUic <br /> IYPE j�{ Demolition LJ Sign TYPE j_,� New �._/ Gas <br /> I] Sprinkler L.I RepairlMaint. U Other <br /> CONTRACT PRIC[OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> WORK DESCRIPTION '/Vj��Jz �� �iff - '" !�f'/..';�-X�f} � � <br /> r- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATERCLOSET(�OILEI') _ A/C-,'�/HAN�LINGUNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATCRY(WASH BASIN) _ HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY � VJATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> I _ DRINKING FOUNTAW _ GAS FIREPLACE <br /> � FLOOR DRAIN GAS RANGE <br /> 6ACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BARIMOP/ETC.) _ EXHAUST rAN <br /> OTHER _ _ OTHER <br /> � <br /> I I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPI.ICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPEGFIED HERF.IN OR <br /> ! NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIV[AUTHORITI'TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW RL'GULATING CONSTRUCTION OR THE PERFORMANCE CF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNEf2 OF TfI�S PROFERN TO PERFORM THE WORK FOR WHICH APFLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � CONTRACTORS W t8.27 C AND 296.200 WAC. <br /> // ,_,i(�� l?��+'—1 //� <br /> S g�at�e oF�(Ownen ntr ctor/Authon.ed Agent T� ate <br /> �__ DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />