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PtRMIT APPLICATIt,N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> N -3n -o� <br /> SI*E ADDRESS PARCEL TAX I.D.# PE iT tt <br /> Il�i�� s.l� << 1.,�,�� _.�����kN l'Yl�� Q��S '1 �'occ.�oo z c� -2C� <br /> LEGAL LOT NO. J NC " ���4- BLOCK TRACT 1 * <br /> DESC. � �� � c�{[,��� CCC � D- U > � IVQ�L y.r}Kc IJ4 �L �}-� <br /> OWNER ADDRE55 -��� �2/��p 21P PHONE ,ys—_ <br /> K�2� stz:nl 1�l T�10/'Sf��uSo,J ll �t2. ( v � � � er �- aKcU,�. <br /> TENANT NAME I CONTACT FOR PERMIT PNONE <br /> C'c�-n)t� .S-r �� �r��0��zur� t,r �Fn '7�l-vsS'S3 <br /> CONTRACTOR L,1 �,� ���y��,�u�fi�� ADPRESS /Z.1�S �'��£ �,� 21P CONTR.L�CENSEN <br /> cJ �j /� /, ' C �y '/ <br /> PHONE U�I!'Ii�t�Jz�\ KJR / cCC3�J S1�COM1� I�I ��lt <br /> 34"�� ����' a»� � ' ,,�� 7.� 7-�<<�� <br /> PROPOSED USE OF BUILDING Building � Mechanical AtlCilion HEAT SOURCE <br /> PERMIT R Combination Plumbing WORK � Alteretion � Elendc <br /> TYPE Demolition Sign TYPE New �' Gas <br /> ��„'��.,�„ �,� � Sprinkler RepairiMainc Other <br /> CONTRACT PRICE OF WORK ?ti����-� CITV OF EVERETT LOCAL SALES TAX CODE IS 310d <br /> WORK DESCRIPTION � � �� " <br /> '�: t-.�C- �.�, oo -� �� ti� �(/,�`U�-. <br /> i �� ; <br /> i <br /> PLUMBING MECHANICAL <br /> NO. TYHE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLO�HES DRYER <br /> DISHWASHER RAN E HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER. METAL FIREPIACE/STOVE <br /> = URINAL �. FIREPLACE INS�Rj <br /> DP.INKING FOUNTAW � GAS FIREPLACE \ <br /> FLOOR DRAIN �� GAS R4NGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OThIER ._ <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAA7INED TiiIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br /> PROVISIONS OF LAINS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GHANTING OF A PERMIT DOES NOT PRESUtdE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTiON OR?HE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE 1VORK FOR WHICH APPLICATION IS MADE 4ND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200\VAG. <br /> � r " <br /> ' -<,��� � / `�3�3� b 5S <br /> Signature of� wnedC6ntractor/AuthonSled Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED I/Z <br />