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i <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 /> ��7�� <br /> SITE ADDRESS PARCEL TAX I.D.� PERMIT# <br /> ' RSt�tNbT u� �e �5��[�ooz!oo wr�` �q/» -�11L <br /> LEGA LOTNU. BLOCK TRACT <br /> DESC. �y _ <br /> Z L � <br /> OWNER DRESS ZIP PHONE <br /> Dfl�ili� LnriNAi l /ri7�/1 �ra�� ii �r � r inu - ,-ocTri�.J� qA� U ���QgyL <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I CL.Ny F��� tJ <br /> 3c;uN con�Sf���Z'io IN� �4�5� 35 7o7Ca <br /> CONTRACTOR UN CCNS'T,'TN(. . AODRESS PG� }�- 21P CONTR.LICENSEN <br /> $nX 21 <br /> PHONE (Ha5) 3 S 3 -707� M.l�-k1L'j�J r W�. 9Qi2'7'S �'l-IN�101 N.� <br /> PROPOSED USE OF BUILDING I fl Building Mechanical Addition HEAT SOURCE <br /> PERMIT K Combination R Plumbing IWORK R PJteretion n Electric <br /> IYPE �__l Demolition � Sign IYpE D New ❑ Gas <br /> S�Nf.i,E I-l�1M�� LJ Sprinkler U Repair/Maint. D omer <br /> CONTRACT PRIL6 OF WORK I 2�,J n p CITY OF EVERETT LOCAL SALES TAX CODE�S 3105 <br /> /O <br /> WORKDESCRIPTION �./Eh7 GONSTR.�.�tTl[N 1 -�in�bCCFf�Mt�..+ ew�u..�Nb � . <br /> PLUMBING MECHAMICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF F�XTURE OR ITEM <br /> _i� WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> 2 BATHTUB FORCED AIR SYSTENiS <br /> -1�, LAVATORY(WASH BASIN) HEF PUMP <br /> / � SHOWER ,� UNIT HEATERS <br /> 1 KITCHEN SINK 8 DISPOSA� � CLOTHES DRYER <br /> � DISHWASHER _j_ R,4NGE HOOD <br /> LAUNDRY TRAY ,� WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREF�ACE INSERT <br /> _ DRINKING FOUNTAIN �_ GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTEF �� GAS PIPING <br /> _ SINK(SERVICE/BAR/MOPlETC.) ,�_ EXHAUST FAN <br /> _ OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATIOh AND KNOW THE SAME TO BE TRU'E AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETFIER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF,4 PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THL PROVISION OF ANV OTNER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTFIOR12ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.2001NAC. <br /> Signature of OwnedContractor/Authonzed Agent Date � ` <br /> � <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED ��2- <br />