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P�RMIT APPLICATIO�N <br /> CITY OF FVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAl(I�D.N P,E�iM'\I�7/O�` � <br /> 7 � e,,� oy�S3 - � 0� -003 -�o X�t <br /> LEGA LOTNO. BLOCK TRACT A ' � ) <br /> DESC. � � l� 3O�I H�I�rj �I'S� /fdOli'M1OiI �s �i/!•� <br /> OWNER - ADDRESS 21P PHONE <br /> _� �J+f�'��n5c/1 � 50"] RJc.kCf ��101 a5'9— AS�S <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> ,����� E-�,�cl� ,;,5,,, h(I�ke, Lc��sen ti1s- 3�1, �S3s <br /> CONTRACTOR��en p ^5+ ADDRESS ZIP CONTR.LICENSEN <br /> PHONE � 31n A�I�c�sa, B1�� q��o� �ARSEc � �oiDN <br /> ti�s- 3a�- �s3�r <br /> PROPOSED USE OF BUILDING BPilding p( Mechanical I AtlPitlo� I HEATSOURCE <br /> PERMIT Combinalion P�� Plumbing WORK A�leration R Electric <br /> p S;d�� TYPE Demolition U Sign TYPE New �] Gas <br /> f�e S rinkler Re air/Maint. U Other <br /> CONTRACT PRICE OF WORK /_85 D I D C�TY OF EVERETT LOCAL SALES UUC CODE IS 3105 <br /> Y' � <br /> WORK DESCRIPTION p f I_ I i�J^/�� I 1,`�_G` �1 A � �n Q���) <br /> PR�7� a F� Tx.r� 0. lk�.l iWOf�nS <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF PIXTURE OR ITEM <br /> l WATER CLOSET(TOILET) AIC—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BAS�N) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _L KITCHEN SINK&DISPOSAL �_ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRA'f WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DFINKING FOUNTAIN GAS FIREPLACF <br /> FLOOR DRAIN GAS RANGE <br /> 6ACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SFRVICE/BARIMOP/ETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> � <br /> I I HEREBY CERI7IFY THAT I HAVE READ AND EXAM1IINED THIS APPLICATION AND ICNOW THE SAME TO BE TRUF AND CORRECT. ALL <br /> I PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL 6E COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIr"..r��t OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR TH[PERFORMANCE OF(.ONSTRUCTION. TH1T I AM AUTIiORIZFO BYTHE <br /> OWNER OF THIS PROPERTY TO PE RFORM THE WORK FOR WHICH APP�ICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW hIJD 29�6.200 W�C. <br /> y1�'�.G-� �(%y9'� y-z;-vy <br /> Signature of OwnedContractor/Authonzed Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />