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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8657 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �oo� u �}d� �y z �o/ 70 lOs $oyol-�3C� <br /> LEGA LOTNO. BLOr,K TRACT <br /> DESC. <br /> OWNER ADORESS ZIP PHONE <br /> DA�4�c �^���Rk�,J An�O�so,� a�l Rucke2 tWk. 98zor 4'25-zsz-�z5ti <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> u��u- �kkn Yzs so� 3,Y� <br /> CONTRACTOR AODRESS 21P CONTR.LICENSE N <br /> !/���k 6r3i INc . S7io bbt�R�d6 /�� q�Sz�o c7r8�- <br /> PHONE <br /> �f�o 6S3 2s ly td18�EZ�'`1�73h <br /> PROPOSED USE OF BUILUING I &j Building 11 Mechanical I Addition I HEAT SOURCE <br /> PERMIT �-� CPmbination f-� Plumbing WORK �AllPratlon � Eleclric <br /> 37nI�cE Fq�t+icy pwkcunlc, TyPE K Demolition L/ Sign TYPE NeW Gas <br /> I.J S nnkle� Re airlMaint. Other <br /> CONTRACT PRICE OF WORK 3 500•�' p CITY OF EVERETT LOCAL SALES TAl(CODE IS 7105 <br /> WORK DESCRIPTION <br /> ��R o�D /ZooF �n15tAu Nkc.� <br /> PLUMBING MECHANICAL <br /> NO. TYFE OF FlXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BAS�N) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> �ISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> j I HEREBY CERITIFY?HAT I HAVE RcAD AND EW+MINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED:.cREIM OR <br /> I NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTR'JCT�ON. THAT I AM AUTHORIZED BY THE <br /> ! OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MAD�AND 1 COMPLY WI'i H THE STATE <br /> CONTRACTORS 18.27 RCW AND 296.200 WAC. <br /> j-�-oy <br /> Signature of OwneqContrecrodAuthonzed Agent Date � <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />