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P_RMI�' APPLICATI�,N <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.N a MIT w <br /> Z ule� �nv� Ctie�etL �2,w3 47 0�- -G� <br /> LEGA LOT NO. BLOCK TpqC7 <br /> DESC. �1 LiL 47 cvta.. �Ic.t�� Valw-.�e. ll , peyc 52 �no �6Un.� � <br /> OWNER � b"�,�I ' AODRESS ZIp PHONE -S (� ' <br /> � � � n �t l�(.�a' S(�Z l,c)e_.)�- �U� C-�e.c¢�f..t �t'k263 <br /> NANT NA E . . I CONTACT NAME PHONE <br /> C,�O ACTOR ADDRESS � Zlp CQNTR.LICENSEN <br /> PHI(�t�ke.r Consh'uch�Dh 3s4-7 iu E l�2 5}- ��� TU C kE G 681 <br /> 20(Q 5�0 7�3 ���ss <br /> PROPOSED USE OF BUILDING Building Mechanical Addilion HEAT SOURCE <br /> I PERMIT � ComGination � Plumbing IWORK � Alteretion � Electric <br /> TYPE Demolition Sign ITYpE New Ges <br /> Spnnkler(x of heatls) � Repair/Maint. .I Other <br /> CONTRACT PRICE OF WORK n ^^ �X '6 1 '�C��D �CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> \M/1/i <br /> WORK DESCRIPTON <br /> �dd �ZS scb{� t� ��sh�wy h�. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR REM NO. TYPE OF Fl%TURE OR REM <br /> WATER CLOSET(TOILET) _ A/C-A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> Z LAVATORY(WASH BASIN) / / _ HEAT PUMP <br /> � SHOWER I _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER � <br /> DISHWASHER RANGE HOOD <br /> � LAUNDRY TRAY� � WATER HEATER <br /> L CLOTHES WASHER / _ METAL FIRtPLACE/STOVE <br /> _ URINAL FIHEPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> %� FLOOR DRAIN GAS RANGE <br /> T BACKFLOW PREVENTER GAS FIPING <br /> ,.k_ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST Ff�N � ,y <br /> _ OTHER � OTHER �Cpi�tin+ ,�i;�� �[U <br /> I 4EREBY CERI7IFV THAT I HAVE PEAD AND GXAMINED THIS APPLICATION AND KNOW 7HE SAME TO BE TRUE AND CORRECT. ALL <br /> PROV:SIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED WITH WHETMER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A?ERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> 5T47E OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> C RACTOfjB �8. 7 AND296200WAC. <br /> � <br /> / <br /> Si ture of nedConhact dAuthonzed Agent Date ��-\ <br /> - �� <br />