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� PERMIT AP�LICATION -�! <br /> I� CITY OF EVERETT IPERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 <br /> SITE ADDRESS PAF:CEL TAX I.D.# PERMi7 x <br /> ��z �%7���. �;Kee{- C-r� roc�d �cY�o��l �/��0 - ��'' � <br /> LEGA LOTNO. BLOCK TRACT I <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> �E l��m Ce �ri ` -f A �1�2111 (�Its) 2�z -zL�U <br /> � t.i,G 7-l�� (louc cl�r'r ��-� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �>�lc k�o«(a�c� ��IZ�) `�t�k — �-1`I <br /> CONTRACTOR ry C�,� ��� ADDRESS .(�� /��� x�2'1 ZIP CONTR.LICENSE# <br /> yL'Y1(1i� }�t.cf6vS 1�"x <br /> PHONE � . `, � `CJeiz�-(� i ��1 ,A� Ikl�'� ��Yn�PCG ��t�PZ <br /> �15 �I -� - �1b1 <br /> PROPOSED USE OF BUILDING n Building Mechanical Addi��on HEAT SOURCE <br /> PERMIT �� Combiralion R�-( Plumbing WORK Altaration Q Electric <br /> TYPE j�l Demolition U Sign TYPE �ew �j Gas <br /> U Sprinkler P.epaiUMaint. U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> I� ��IIC� � ��������� ���IL �S c�ti� 4�{�O �:�i�.i� c.�•�� � �J��.�c�i'�i�(� <br /> ! ( cQar�•. S���ea � Acre Tiwc-1s �Iltc�r�9 1�-iY S. 5�� c�- �-Iwf �os� d�� 4 k�, a�' olle <br /> PLUMBING MECHANICAL <br /> NO. TYPE 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 /> ;AVATORY(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 I <br /> BACKFLOW PREVENTER _ GAS PIPING II <br /> SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER I <br /> I — _ _ I <br /> � — <br /> i — <br /> I! I HEREBY CERITiFY THAT I HAVE READ AND EX4M1iW ED THIS/�PPLICATION AND KNOW THE SAME TO 6E TRUE AND CORRECT. ALL �, <br /> iPROVISIONS OF LAWS AND ORIDINACES GOVE4NING THIS TYPE OF WORK WILL BE COMPLIED WITH�:�HETHER SPECIFIED HEREIN OR � <br /> NOT. THE GRANTING OF A PERh11T DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOLATE OR CANCE L THE PROVISION OF ANY OTHER i <br /> STATE OR LOCAL LAVJ REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE I <br /> OWNER OF THIS PROPERTY TO PERFORP.1 THE WORI<FOR V'lHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE i <br /> CONTRACTORS LAW 18.27 RCW�AND 2�96200 WAC. �� <br /> �J'yL1py,p �/_ r—�",� (v���v� I <br /> Signatur" e of15`wnerlContractorlAuthorized Agent ate r <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEP i ED \` � <br />