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F �RMIT APPLICATIvN <br /> �I CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> �o -09-03 <br /> � <br /> SITE ADDRESS PARCEL TAX I.D.q PERMI7 u i <br /> �> s�AHv.�sT Avc 3�z5' c� �3 oS� oo ov /1 3ia _oo.S� � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. i <br /> OWNER A�DRESS ZIP PHONE <br /> /-�,��i��s k�yc /c soz c SEAy�'ST AuG 9Szv3 ��S3w 9i -� <br /> TENANT NAME CONTACT NAME PHONE ii <br /> � <br /> CONTRACTOR ADDRESS 21P CONTR.LICENSE N I <br /> PHONE I <br /> �W r-1Lh� <br /> PROPOSEO USE OF BUILDING Building Mech�nical Atldition I HEAT SOURCE <br /> PERMIT RI--( Combination RI--( Plumbing WORK RF-{ Alteiation � Electric <br /> I TYPE �j Dem0liliOn �J Sign TYPE �j New Gas <br /> �A�A���� L� Sprinkler LJ RepairlMainL Other <br /> CONTRACT PRICE OF WORK CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> � �. <br /> �_� ,� s <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> VJATERCLOSET _ AiC-A/HANDLINGUNITS <br /> BATHTUB _ FORCEU AIA SYSTEMS <br /> LAVATORY�WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRYTRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> II _ URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> I FLOOR DRAIN _ GAS RANGE <br /> I BACKFLOW PREVENTER GP.S PIPING <br /> ' I SINK(SERVICE�BAR/IdOP/ETC.) _ EXHAUST FAN <br /> i OTHEA _ OTHER '� <br /> — _ — II <br /> �I I HEPEBY CERITIFV THAT I HAVE READ AN�E%AAIINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAbYS PND ORI�INACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN Oii I� <br /> NOT. THE GRANTING OF A PERIdIT DOES NOT PRESUAIE TO GIVE AUTHORI7Y TO\'IOLATE OR CANCEL THE PPOVISION OF ANY OTHER i <br /> STATE OR LOCAL Li1W REGUTATING CONSTRUC1lON CR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> i OWNER OF THIS PROPERTY TO PEflfORld THE 1YORK FOF WHICH APPLICATION I i A1ADE AND I COMPLY WITH THE S7ATE li <br /> I CONTRACTORS LAW 78.27 RCW AND 2°6200\NAC. I <br /> � ? �' /D/Z�l3 I <br /> �I +�-� 'f. — <br /> i Signature OL wrLe rConiractor/AWhonzed Agent Date <br /> �'Z il <br /> I DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />