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�NERM�T APPLICATION <br /> CITY OF EVEFtETT PERMIT SERVICES <br /> 3200 CEDAR Sl'REET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> SITE AUDRESS 1 PARCEL TAX I.D.# PERMIT# <br /> r�US S;1JCr 11,�1� . X �3oy-n�is <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> Mbv�nl c.•,.i lJ' c�..� ?o�« �'� 1 . �!z i L95 v �o�-� <br /> TENANT NAME CO TACT FOR PERM�T PHONE <br /> I.�C.�Gf: u�,�neS 1�� . I ���� !�� v �-( '-/2i 25 � - u ��... <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSEN <br /> 5 , 3 �. 7A,,��� �.,� r �z�C <br /> PHONE t-�2 ) Z4 5 - v � O'� ,�li�i-�. ��. ��e✓c.,i > �✓A 4 : z>�- <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> I�ERMIT R�.-( Combinalion � Plumbing WORK R Alteration I D Elechic <br /> TYPE �( Demolition U Sign ITYPE D New [�Gas <br /> • I IJ Sprinkler � RepairlMaint. U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION r <br /> �^ ��.cC\ n: r 1 �( SI�f`' �,�+ `n1� <br /> .'�i� c� Nc�.J }� <br /> � MAc�G Cur!'ccf��u,� , � L-N:.�f:.. �lti,.-.(.'.v� t,c%�«� �c.✓ .�� A /1c..� . <br /> — PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FlXTURE OR ITEM <br /> �C WATER CLOSET(TOILET) A/C—AIHANDLING UNITS <br /> BATHTUB K FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ NEAT PUMP <br /> UNIT HEATERS <br /> � K T�HEN SINK&DISPOSAL ?•��^`Q/ ���� _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRYTRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE�NSERT <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 Me,a�I•...� _ OTHER <br /> -�.> — :,✓_ . _ <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THc SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPIIED WITH WHETFiER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh1E TO GIVE AUTHORIN TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED Bl"THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY Y."T.H THE STATE <br /> CONTRACTORS LAW 10.27 RCW AND 2�.200 WAC.,. . ---�—��----�.. <br /> _ � ��lu�a3 <br /> Signature of Owner ontractor/, orized Agent Date <br /> i' <br /> � DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />