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�ERMIT APPLICAT��JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, �VERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> /D7 // <br /> I SI7E ADDRESS /O�]�II W/¢• w�`1 PARCEL TAX I.D.N ERMiT e <br /> tJG,e.' // ��>f�-� GY� 55a.5 000 oa � oC� �n3o l� -0/7 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. � � �(aiv�.a�o T,vYE�c.i: Ow�ta�v No•3 <br /> OWNER � ADORESS LP PHONE <br /> �P�Ut' t�t-7.SHR+.� Iv7/l �JR.lJi� �J.E2A:-�cJA-- �Z�7 C�S)355-2115 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> N/r�r C'.�-t�`-1 Qal.�n� aoUrJconxr.T�c_. �/-6z5)35 3-�o7Cv <br /> CONTRACTOR ��(,��V[DiIiST. TNC�• ADDRESS P� .g�,x32,` ZIP CONTR.L�CENSE♦ <br /> / Mt.K-��'Ep �•�t�. SoUNLt 10\ I`tiF <br /> PHONE(�C�S) 3S3'-707C9 f �1�Z7S+ <br /> � <br /> PROPOSEDUSEOFBUILDING Building f� Mechanlcai D Adtlition NEATSOURCE <br /> ���,�FI�, �N�I PERMIT � Combination i-� Plumbing WORK Q Alteratlon I � Electnc <br /> SN/�� i'�MI�y nPE Demolition J Sign 7YPe �j New Gas <br /> , Sprinkler R9 Repeir,'Aaint. Other <br /> CONTRACT PRICE OF WORK SU� DDU CITV OF EVERETT LOCAL SALES TA7C CODE IS 9105 <br /> WORK DESCRIPTIr,N <br /> �i� �R,�z�s?.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FO(TURE OR ITEM NO. TYPE OF Fl%TURE OR fTEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> � BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WAS�i BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLqTHES DRYER <br /> _ DISHWASI�ER c� RANGE HOOD <br /> LAU�ORYTRAY YVATER HEATER <br /> CLOTHES WASHER MEfAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR�RAIN G,�S RANGE <br /> BACKFLOW PREVENTER GAS ?IPING <br /> _ SINK(SERVICE/BAR/MOP/ETC ) I EXHAUST FAN <br /> I = OTHER — �THER <br /> I HEREBY CEHI-IFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE�4ME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAVJS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITF WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE Gl�ANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OFi CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW FEGULATING CONSTRUCTION OR THE PERPORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNEP OF THIS PROPERTY TO PERFORM THE WORK FOP WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOHS LAW 18.27 RCW AND 2?6200 WAC <br /> ���l���i✓l�.�JST:2iJG �1-//�d� <br /> Signature of OwnedContro todAuthorizetl Agent Date �/L <br /> L DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />