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i <br /> , <br /> PERMIT APPLICATION <br /> CITY OF EV�RETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> 3 -5—� � <br /> SITE ADORESS PARCEL TAX I.D.# P RMIT tt <br /> ' � -��/ / <br /> `��c��' ,� ,-` .. zeti, �J _ � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ,_ �bp� �U� �_L ADDRESS ZIP PHONE 2 <br /> �/l v�'iey-t�� J`���uoac �is�k�c��tl°�, t`i'�� ,�u�ee� P-�l �82c�1 <br /> TENANT NAME CONTACT FOR PERMIT �C�N ��N� PHONE <br /> �nn ��c,M�ti���,a�..- rNa2s. l�b •�21�o� <br /> CONTRACTOR ' ` ;�',!-, '�;;.� �,..'� ( ADDRESS ZIP CONTR.LICENSEM <br /> PHONE <br /> �. Z�'_ <br /> P�tOPO5E0 USE OF BUILDING � � Building f, Mechanical I� Addition I HEA7 SOURCE <br /> °' y;�iLlt��-7�-l�cC� �j�S�Vii-'. I PERMIT Combinalion �_� Plumbing WORK bq(t Alleralion QElectric <br /> ',, � i . i=,���j7y.= TYPc �Demolition LJ Sign TYPE �J New �g Gas <br /> ;�.IYI:.I''1( �'i� �= i-� � U Sprinkler U RepaidMaiN. U Other <br /> _�> <br /> CONTRACT PRICE OF WORK �—�L l/V C� S '' ���� /l(,r(I CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORK DESCRIPTION � r <br /> �'E=/'i-�416 C=X/ST1M�j �f�LlNc «'lLI�1y � k'EC�.SS�/� �LI�U/ZESCe".�tl! <br /> T- l'1 L !rN n�v; �.y s .rii�i s � �i�f'� i,�� d 7<�.'�� �` �-� os <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> WnTER CIOSET A/C—AIHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> L/1VnTORY(WASH BASIN) HEAT PUMP <br /> SHC�WER UNIT HEATERS <br /> KITCH[N SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER _ IdETAL FIREPLACEISTOVE <br /> URIN�L FIREPLACE INSERT <br /> DRINKING fOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVEiJTER GAS PIPING <br /> SINK(SERVICE/BARlMOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAV[i. -AD AND EXl�h11NE�THIS APPUCATION AND KNOW THE SAME TO DE TRUG AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINAC[S GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. TH[GRANTING O�A PERAf1T DOES NOT PRESUM1IE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTh!ER <br /> STATE gR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTP,UCTION. THAT I AM AUTHORIZED BV THE <br /> OW OF THIS PROPGRTY TO PERFORM1I THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CO RACTORSLAW 27 W AND296.ZOObVAC <br /> � �/ l � i�'ll �� '��9 Z�/v�' <br /> S�n'f�r of Own�dConlractodAuthorized Agent � Date <br /> 1 <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED ��- <br />