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PtRMIT APPLICATIUnI <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810— FAX 425-257-8857 � <br /> ��ISITE ADDRESS PARCEL TAX I.D. # PE���^���� �I <br /> 2423 v��w GQfs7 Av� 5��� - 003 Oo9 Ooo 4 � 4�� ' Z D � <br /> � LEGALf LOT NO. BLOCK TRACT I <br /> �� DESC�T � 3 P���7 0� S�.<=.vi�u� I�F �4�T5 <br /> �i OWNER AD�RESS ZIP PHONE I <br /> , N� � c,���s G���,-, z 2a v���ueesr puE 425• 353- S�o'7 '� <br /> I TENANT NAME CONTACT FOR PERMIT PHONE � <br /> I <br /> I�,��6 C-, ou�� 425 - 353 -S�o� i <br /> � CONTftACTOR ADDRESS ZIP LONTR. LICENSE N <br /> I PHONE <br /> Q.�.(N�K <br /> � PROPOSED USE OF BUILOING �i Euilding I� �vlechanical I� Atldition HEAT SOURCE <br /> � PERMIT �� Combinalion F_� Plumbing WORK �__� Alteration D Eiectr�c , <br /> � S I N�L� �A M 1�Y TyPE � Demolition L1 S�9n Tvae �' New IJ cas � <br /> , ��5�� ��� �� Sprinkler L� RepainMa�nt L� Other <br /> i CONTRACT PRICE OF WORK $L ^OU I CIN OF EVERETT LCCAL SALES TAX CODE IS 3105 � <br /> LS.J <br /> �I WORK�ESCRIP'iION � <br /> , COIJUF Q"( �X15�I�V 6A(LAG� 1�17� �-hlirJ�i SPACF ��AM��Y ��M� <br /> I PLUMBING MECHANICAL I <br /> ' NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM � <br /> ' WATER CLOSET(TOILET) _ FVC—A�HANDLING UNITS � <br /> I BATHTUB _ PORCEU AIR SYSTEh1S � <br /> LAVATORY(WASH BASIN� __ HEAT PUA1P � <br /> I, SHOWER _, UNITHEATERS ', <br /> � KITCHEN SINK E DISPOSAL CLOTHES DRYER � <br /> DISHWASHER _ RANGE HOOD ,, <br /> LAUNDRY TRAY _ WATER HEATER I <br /> CLOTHES WASHER METAL FIREPLACE.�STOVE � <br /> URINAL FIREPLACE INSERT <br /> � DRINKING FOUNTAIN GAS FIREPLACE �, <br /> FLOOR DRAIN _ GAS RANGE I <br /> BACKFLOW PREVENTEF i _ GAS PIPING , <br /> SINK(SERVIC6BARiA10PlETC.) _ EXHAUST FAN ' <br /> OTHER _ OTHER , <br /> I HEREBY CERITIFY THAT I HAVE REA�AND EXAIdINED THIS APPLICATION 4ND KNOW THE SAME TO BE TRUE AND CORRECT. ALL � <br /> PROVISIONS OF!.,4WS.:ND ORIDINACES GOVERNING THIS iYPE OF WORK'cVILL 9E C0�IPLIED IVITH WHETHe"R SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PER611 i UOES NOT PRESUME TO GiVE rUTHORIN TO VIOWTE OR CANCEL THE PROVISION OF nNY OTHER <br /> STATE OR LO AL LAW REGULATING CONSTRUCTION OR THE PERFORM1IANC'c OF CONSTRUCTIOIJ. THAT I i�Id AUTHORIZED BY THE <br /> �i�.�NE OF T �5 PROPERTY TO pE�RFORM TH IVORK FOR IVHICH APPLICAT::,N IS 1:1ADE AND 1 COMPLY 1NITH THE STATE <br /> �;;:NT ACTO 5 LAW td.��7 r�Cl�ANO-96.� AC. <br /> J / I <br /> � <br /> (� ' '0 <br /> S�❑ . of wnenCon ctoiiAuthori�ed .�unt Date ��� <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />