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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,# PERy�T tt_ <br /> '�� � ��,C �� K� �I• . � AL� , Iv/Y.��s��c e�� � �qc IOG� ��f �a'S <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. � Z -� �Cq � ��, LV ;:�0 �� �L • <br /> OWNER ADDRESS 21P PHONE <br /> ��il?.i 1-� SGN�Zv(-df-2 ' Z Gi� FFi�r2tSu,�i �°�'r � �5'Zci - �/L5�3.�9�Z2. 7�1_ <br /> TENANTNAME CONTACTFOR PERMIT PHONE <br /> +-'.�. . � f�`'1�� <br /> � <br /> f 1'1�, ��L �%�_?f:���n� -.'Pi.��n'�lilli�l Kur.�� �. .SCf���fihl7F1� =� 7J� � >:�, .Z2. ��i <br /> CONTRACTOR � ADDRESS ZIP CONTR.LICENSE it <br /> � �i�.J":�-!'. <br /> PHONE , i.JJS - �Z::�_ � 7 �^� <br /> PROPOSED USE OF BUILDING � roIq� Buildi�g � Mechanical AdCilion HEAT SOURCE <br /> ( � �1� �" PERMIT � ) Combination Plumbing WORK R Alleralion � Electric <br /> f >�,T-� � J' , i� :�r�rtl TYPE Demoliliun Sign IYPE R New Gas <br /> B Sprinkler ll Repair/Maint. Other <br /> CONTRACT PRICE OF WORK _ ���� � � ,��r��/L�- CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION I_�. ��.14� (-l'L� J` ✓� �i���� S I �lZI�Lv''IY � '��'!=✓ 7/I�PV! <br /> _I l.% L OU�N , )�1 G'_ �. �. i/,� ('? ;.S���J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTt1RE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � <br /> WATERCLOSEI (TOILET) A/C-A/HANDLINGUNITS <br /> BATHTUB FQRCED A�R SYSTEMS <br /> LAVATORY(WASH BASIN) HFAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HO00 <br /> LAUNORYTRAY WATER HEATER � <br /> CLOTH[S WASH[R METAL FIREPLACE/STOVE <br /> URINAL FIREPLACG INSEFT <br /> � DRINKING FOUNTAIN G.4S F�REPLACE <br /> �I = FLOOR DRAIN = GAS RANGE ' <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE�u1PJA".OPiETC.) EXHAUST FAN <br /> II = OTHER = OTHER <br /> — — I <br /> I HEREBV CERITIFY THAT I HAVE READ AND E,�(AA1INED THIS APPLICATIJN AND KNO'�N THE SAME TO BE TRUE AND CORRECT. ALL I <br /> PROVISIONS OF WWS AND ORIDINACES GOVERNWG THIS TYPE OF N'ORK IVILL BE COM1IPU[D N9TH WHETHER SPECIFIED HEREIN OR <br /> NOT. TH[GRANTING OF A PERAIIT OOES NOT PRESUM1tE TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER � <br /> �� STATE OR LOCAL LAW REGUW7ING CONSTRUCTION OR THE PERFORtdANCE OF CONSTRUCTION. THAT I AM AUTMORIZE7 BY THE � <br /> I OWNER OF THIS PROPER71'TO PERFOR�d THE WORK FOR 11'HICH APPLICATION IS MADE AND�COAIPLY WITH THE STATE ; <br /> CONTRACTORS LAW 1827 RCIV AND 2�6.200 WAC. II <br /> � � � ,� /i-� � ,1� �,:��:;: �� l. �2�.! � o �-1 <br /> Iignawre of OwneriContractor/Authonzed Agent Dale �/2 <br /> � DEBIT & CREDIT CARDS ARE NOT ACCEPTED _� <br /> �- - <br />