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P RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 6 �5 � G <br /> 425-257-8810- FAX 425-257-8857 O I � /� <br /> SITE ADDRESS PARCEL TAX I.�.N PEttMiT � <br /> �9a� - avY3 0 - -oi ce <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. gO6 �OO E(�L� �4A' <br /> OWNER ADORESS ZIP PHONE <br /> ,%��?ES�1 �i�r/.U��P i 9e?7 /.�E`r'is,b,e� �r.�P�.� SG23-FJ 76- 99�9 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ,�o. ���-a3�3 . <br /> ��E -s�P � � � 0 -75,7-65�3� id� <br /> CON CTOR ADDRESS ZIP CONTR.LICENSE/ <br /> S��e�sT �ag.zs-Er��� o,� 12�1� 9&�33 s��. , iy/ �' <br /> PHONE �j'i.l,�L/NG%ON W� � I <br /> �/�2,757-/�4�3n <br /> PROPOSED USE OF BUILDING I�,�Building [�'Mechanical Addition HEAT SOURCE <br /> �C�,���L PERMIT KI--( Combination �f Plumbing WORK Alte2tion R Electric <br /> C{� 7YPE �.J Demolition lJ Sign TYPE New �j Gas <br /> .']_... :�6 J/ IJ Sprinkler Repair/MainL U Other <br /> �KlJ�G! <br /> CONTRACT PRICE OF WORK 35��O CITY OF EVERETT LOCAL SALES TAX COOE IS 3705 <br /> WORK DESCRIPTION <br /> �iQ�� ��ovsc � piiT C/•dC.c��c fod.v,t•rJTio.rJ��r/ . <br /> r'vr Ncw cAa„J�s •�v ,r'�c�urJ — �i d/raJ �� o,U :t.��e c�o�o <br /> ; _ Goc.I�rL�,sT�� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLQSET(TOILET) _ A/C—AIHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&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 GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> T_ s — <br /> I HEREBY CERITIFY THAT I HAVE READ AND Ex,4MINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEf2 SPECIFIED HEREIN OR <br /> NOT. THE GR4NTING OF A PERMIT DOES NOT PRESUA1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LA\N REGULATING CONSTRUCTION OR THE PI:RFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OINNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH ThiE STATE <br /> CONTRACTORS LAW iB27 RCW AND 296.200 WAC. <br /> � � � � LZ BS' � <br /> Signature of Owr� dContraclorlAuthonzed Agem ate � <br /> Z <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />