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i � <br /> PERMIT APPLICATION <br /> i CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810- FAX 425-257-8857 <br /> s-�y �s <br /> SITE ADDRESS PARCEL TAX I.D.# PE iT u <br /> n��'l G✓�.`���tE% /�v� . �9d9 C�31� <br /> LEGAL✓ LOTNO� BLOCK �iRACT <br /> DESC, <br /> OWNER , , ADORE/SS ZIP PHONE <br /> ����t '� �T�',��{`z< / yi c_ l,�- ./� �C6 �3�`(.sl� 1���/ �S�t��,ZsY-9�b' <br /> TENANT NANE � CONTACT FOR PERMIT PHONE <br /> (�u�c.cc��a� ��c���cdsl���w�� �c�a�c E ��-1��� ��s�Za`y-�C-�?_ <br /> CONTRACTOR - ADDRESS ZIP CONTR.LICENSE# <br /> .1,.���c���/ s,«.;c «� �G��>� <br /> PHONE <br /> �ClHC CIS c���,` <br /> PROPOSED USE OF BUILDING Q 6uildi�g � Mechanical nL� Adtlition HEAT SOURCE <br /> PERMIT � Combin2tion Plumbing WORK �) Alleration � Elecvic <br /> �' �,j TYPE Demolition Sign rvPE � New Gas <br /> °L�-c� ; rz`1C'�f�- Sprinkler RepairiMainL Other <br /> Y <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CO�E IS 7105 <br /> WORK OESCRIPTION ___j _ � �/ ( � / pr e � �" / r <br /> j(c[�C o f/Y`C�� CC�d f'!'YL. (i c �.f slj��l�!v� <br /> ` � �,,?SL�'V <br /> (clSic�.vr�.�x ltd'r�elc� <br /> PLUh1BING MECHANICAL <br /> �I N0. TYPE OF FIXTURE OF ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A/C-A/HANDLING UNITS <br /> I BATHTUB FORCED AIR SYSTEMS <br /> I _ LAVATORY(INASH BP.SIN) _ HEAT PUMP <br /> I _ SHOW[R _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER I <br /> �i DISHWASHER _ RANGE HOOD �� <br />_ i _ LAUNDRY TRAY WATER HEATER � <br /> = CLOTHES WASHER �IJ, METAL FIREPLACEISTOVE � <br /> URINAL FIREPLACE INSERT � <br /> D R I N K I N G F O U N T A I N G A S F I R E P L A C E i <br /> I FLO�R DRAIN GAS RANGE <br /> � BACKFLOW PREVENTER GAS PIPING � <br /> i _ SINK(SERVICEiBAR;h10P/El'C.) _ EXHAUST FAN i <br /> j = OTHER = OTHER <br /> !i <br /> I HEREOY CERITIFY THAT I HAVE READ AND E.�P.t.4WED THIS.'vPPLICATION AND KNOW 7HE SAI.tE TO BE TRUE AND CQRRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVC-RNIN6 THIS T1'PE OF WORK 119LL BE COMPLIED 1VITH WHETHER SPEGFIED HEREIN OR �, <br /> NOT. THE GRANTING OF A PERMIT DOES�OT PRESUAfE TO GIV't AUTHORITI'TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER ! <br /> STATE OR LOCAL LAVJ REGULi�TIhG C NSTRUCTION OR THE PERFORA7ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE �� <br /> OINNER OF THIS PROPERTY TO PE RA1 THE YORK FOR�l'HICH APPLICATION IS A1ADE AND I COM('_Y 1VITH THE STATE ' <br /> � _�CONTRHCTORS LAW 6.2F 6V D"9 GUO AC. i <br /> ���`� /.��� s7 G � � <br /> ignature o(OwneriContra ouAuthonaed Agent te � i <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED /� <br />