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PcRMIT APPLICATIGN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, E��ERETT, WA 98201 <br /> � 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TA%I.D.fl PERMiT tt <br /> °� i3 �^ 5' /'i.; �,�, r,�r /' r�T- OOr� 100 i�C <br /> LEGA LOT NO. /� j -�,J BLOCK TRACT <br /> � <br /> DESC. f'nc�7-�n�.1 nr. �(��/1JDl�lf=(1J N'uDrT�i n/�/ <br /> OWNER ADDRESS ZIP PHONE ,i j j ZrZ � p <br /> ! <br /> (u r � � l..r•,. +r_� ; � �I �, , , n �F;if;.�r::•r A��t- �-vr ,r.�YT c�li�- `�Q�.o <br /> TENANT NAME � CONTACT FOR PERMIT ��S �I��� PT�, I j�� <br /> �V <br /> � � i�- i �� ' � � / u/c�r � � 3��� �G av 4ZS. �: z .� lc'`t W � <br /> CONTRACTOR " ADDRE55 ZIP CONTR.UCENSEM <br /> � . � . 17 <br /> PHONE ��J�� <br /> PROPOSED USE OF BUILDING 17 BUilding MCChaniCal I pj Addition HEAT SOURCE <br /> PERMIT f�� Combinalion Plumbing WORK �-� Alleralion � ElecVic <br /> �� �3!� �i F.• (..' , I-( h< <br /> TYPE �( Demolition Sign IYPE �j New Gas <br /> /1 l�L-, 7��f ' J LJ Spnnkler U RepairiMaint. O�her <br /> CONTRACT PRICE OF WORK -.r � y �OZ/��� CITY OF EVERETT LOCAL SALES TA%CODE�S 7105 <br /> WORK DESCRIPTION �.�. /\� + i�G- �=r !� U7/7-/('��1 � �-�/� (�S/ PN-��� !�/A�/� <br /> �. ` ��. l�n , r� 'f/ ! / 'f � i�( lf ! j1,T.',. 7�., <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYP[OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ FUC-A/HANDLING UN�TS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> DISHWASHER __ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> � _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GPS RANGE <br /> BACKFLQW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER _ OTHER � <br /> � (u.-���r F-'!- /�/tfN/,U� _ � <br /> I HEREBV CERITIFY THAT I HAVE READ AND EXAMINEG THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAVc'S AND ORIDINACES GO\'ERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR �I <br /> I NOT. THE GRANTING OF r PERMIT DOES MOT PRGSU1iE TO GIVE AU7HORIN TO VIOLATE OR CANCEL THE PRO\9SION OF ANV OTHER <br /> STATE OR LOCAL LAW REG�.ATING CONSiRUCTION OR THE PERFORMkNCE O�CONSTRUCTION. THAT i AM AUTHORIZEU BY THE <br /> O`"�NER OF THIS PROPERTY TO PERFOEM THE INORK FOfi WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � �` TRACTORS LAW 18.27 RCIN AND 296200 WAC. <br /> �:-. �, _._,�:..��f.,, 3 �� � �G S <br /> Signature of Ow�ori ontr orlAulhonzed Agent Date '� <br /> �:. . -��., � . - � � i. . : �: Ji <br /> ' DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />