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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS I PARCEL TAX I.D.7f i'E�9'T u <br /> .L-.��� R�IG Kt�� �}U� [ :'ICr-/-CZ)3 <br /> LEGAL LOTNO. BLOCK TRACT j <br /> DESC. I <br /> OWNER .40DRES5 ZIP PHONE I <br /> IJ/�I,L �I3���SG� �2U�' fZI,LC(,<L�OZ ;�,4"Z �f�LI I <br /> TENANTNAME CONTACTFORPERMIT PHONE �. <br /> . NU pi�Ji'z Pl�ipttRS�t�( �1zs-- zSyt-zzs~� I <br /> CONTRACTOR U,,�I-I�� ��S`r ADDRESS 21P CONTR.UCENSE It � <br /> �ru� Rcx.�<tEi�c�c.�(�aL qea:.�� ' <br /> PHONE 2 J Z�'O�j�{� . <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE I�i <br /> PERMIT R�{ Combination R�[ Plumbing WORK Alteration Electnc <br /> � N Ft r � l�/�f ('� TYPE �.�j Demolition IJ Sign TYPE New � Gas <br /> u Sprinkler Repa�r�Maint. Other I <br /> CONTRACT PRICE OF WORK y y ._ �.J��,� CIN OF EVERETT LOCAL SALES TNC COOE IS 3105 <br /> � WORKOESCRIPTION ��u�.�.K��'y-LO(.l �" I1'��, � I L�K'1 � � ��'I��flt Y ;1^� I'�LL�� <br /> ,� <br /> �) <br /> ���� (til <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � WATER CLUSET(TOILET) _ A/C-A�'HANDLING UNITS <br /> I BATHTUB FORCED AIR SYSTEMS <br /> � LAVA'fORY(WASH BASIN) _ HEAT PUMP <br /> � SHOWER UNITHEATERS <br /> 1 KITCHCN SINK&DISPOSAL � CLOTHES DRYER <br /> I DISHWASHER � RANGE HOOD <br /> r' LAUNDFY TRAY � WATER HEATER <br /> J_ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE � O / <br /> 1 FLOOR DRAIN GAS RANGE C� /� � <br /> J_ BACKFLOW PREVENTER GAS PIPING �` ���l / �/Y t' <br /> _ SINK(SERVICE/BARiMOP�ETC.) � OTHERST FAN i I J„ U � <br /> OTHER — �y <br /> _ _ ���� � <br /> j I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS n�P�iCAT10N AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL I, <br /> PROV1310N5 OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF IVORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR i� <br /> iNOT. THE GRANTMG OF A PERMIT UOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER ��. <br /> STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE PERPORA9ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> , OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR\YHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE i <br /> CONTRACTORS LA�V 1817 RCW AND 296.200 WAC. � <br /> I <br /> Signature of OwneriContractorlAuthonzed Agent Date �/ <br /> L <br /> DEBIT & CREDIT CARDS ARE N07 ACCEPTED <br />