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�RMIT APPLICAT�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> o�� ��a - ��� <br /> SITE ADDRESS PARCEL TAX I.D.# p p <br /> �y`1 V�t�� R�� � ��. , 7UUU 59U! �.�ld DlS <br /> LEGA LOTNO. B OCK TRACT <br /> DESC. �' <br /> OWNER ADDRESS <br /> 21P PHONE <br /> �c��G -+- � Aa-�n�iS r�"I'i(5h JN�I VicaJ �,��c �� �i,ur'� �fi�;�o3 .�5.+. 6`� <br /> TENANTNdME CONTACTFORPERMIT � PHONE <br /> � m,k�. �►,�+ .�o�:- '730 �- �d�� <br /> CONTRACTOR AODRESS ZIP CONTR.LICENSE M <br /> i.v h�ca-� Cc u�t�aC,�- ,� Z 'a('� �A-r k �1-�.�ti._. <br /> PHONE � /�l.-. l.0 I�EJ�TCT �!':N�� <br /> �zs - 3yr� � �3�� m�k�Itu,� ����. 98��� <br /> PROPOSED USE OF BUILDING Building MeChaniCal Addition HEAT SOURCE <br /> I PERMIT �Combination �Plumbing WOR: � Alteration ,�]Electric <br /> �j F- � TYPE Demolition Sign ITYpE New �¢,Gas <br /> Spfinklef Repair/MainL I �U Olher <br /> CONiRAGT PRICE OF WORK . / .� — CIIY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTIDN � <br /> GZ��e�K- �Xis�-�,.� �o,t�c� -1- CfJNS�-�`t,�c,{- iuu� SFIZ <br /> Ue. �..fo�ee�. 5P4C� t938 / �)uis{�L SPd<G. 35A� / `„t"� ,�'�,/ <br /> 7' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. 7YPE O�FIXTURE OR ITEM <br /> 5 WATER CLOSET(TOILET) I A/C—A/HANDLING UNITS <br /> � BATHTUB � FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> � SHOWER — <br /> � KITCHEN SINK&DISPOSAL UNIT HEATERS <br /> �_ DISHWASHER "_� CLOTHES DRYER <br /> � LAUNDRY TRAY RANGE HOOD <br /> _ CLOTHES WASHER � WATER HEATER <br /> UFINAL _ METAL FIREPLACUSTOVE <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> �, F100R DRAIN � GAS FIREPLACE <br /> BF,CKFLOW PREVENT'cR VAS R,4NGE <br /> = SINK(SERVICE/BAR/MOP/ETC.) Z GAS PIP�NG <br /> OTHER _SL EXHAUSTF N, <br /> — _ OTHER (cf Q��,�tiu��' �c�c(' <br /> — �t4�" <br /> I I HEREBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED bVITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERM1IIT DOES NOT PRESUME TO C�IVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHtR <br /> S7ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AU7HORIZED BY THE <br /> OWNER OF TNIS PROPERTY TO PERFORM THE WORK FOR INHIi,H APPLICATION IS MADE AND I COMPLY WITH THF STATE <br /> CONTRACTOR LAb 18.27 RCW AN ?96200 WAC. <br /> Si nature , � L ` 9 I- n� <br /> g OwnedContractoriAuthonzed Agent Date �/ <br /> � DEBIT& CREDIT CARDS ARE NOT ACCEPTED � <br />