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� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> SITE ADDRESS pARCEL TAX I.D.N PERMi7 k <br /> 6a9 k�c o�.0 n o0000 %o — oo r'o �.1 � c�.�.� <br /> LEGAL LOTNtl. BLOCK TRACT <br /> oesc. O -OG TownS! ' o.y� � 0 Se.c, S E Qu , <br /> ONRIER ADDRE55 ZIP PHONE <br /> S1� r 'e�J v, � <br /> TENANTNAME CONTACTFORPERMIT ���ri PHONE <br /> IS�m fl��{,Ceni�e 36o y36 -/ob� <br /> CONTRACTOR �4l _ ( mO���;„ ADDRESS ZIP CONttt.LICEN3E� <br /> I�Wa�lO �nte,� , 'Zj otiN o m 6 oa4L3 <br /> PHONE�o 436-�0�0 �o3a 33 t�r ;� �3�ayr <br /> PROPOSED USE OF BUILDING ttt,,,�������ccc��y uilding Mechanical ���tld�tion I HEAT SOURCE <br /> PERMIT �ombination R Plumbing WORK �uerauon D Elednc <br /> TYPE Demolilion D Sign TYPE New Gas <br /> Sp�inkle� cOairlMaint. B Other <br /> CONTRACT PRICE L•F WORK CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> WORK DESCRIPTION -� 1' <br /> ��Q.CR.. ��CA���n�j 0.v�cS �'10.Y��'r0.� 1 • <br /> E x t�.r.d. ��n o� W'PQ'r roo� o d� de.c� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVA70RY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCIIEN SINK&D�SPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAV WATER HEATER <br /> CIOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RAN<'iE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOPJETC.) EXHAUST FAN <br /> OTNER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE iRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AN�ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECI�IED H[REIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GNE AUTHORII Y TO l'IOLATE OR CANCEL THE PROVISION OF ANY 07HER <br /> STATC OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF l lil5 PROP[RN TO PERFORM TIiE WORK FOR WIiICfi APPLICATION IS MADE AND 1 COMPLY WITH Tf1E S7ATE <br /> C NTRACTOR AN iP 2 D 29ti200 WAC. <br /> � a - <br /> ,�. � �:e, �C I'ZYh� (o-oy <br /> Sig Nre ol OwnedContrad dAu�horized Agent Da�a <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED ,/` <br />