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v; <br /> f <br /> — - t <br /> � � <br /> I , <br /> ' P�r�MIT APPLICATIOnI `� <br /> CITY OF EVERETT PERMIT SERVICES �::; <br /> 3200 CEDAP. STREET, EVERETT, WA 98201 ! <br /> 425-257-8810- FAX 425-257-8857 <br /> r" <br /> ISITE ADDRESS PAkCEL TAX I.D.# PERMIT� � <br /> IEGALL LOTNO. ``�/ � � BLOCK TRACT �� ��'ll , L <br /> � DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ;�-,,, �� ��, f��� C� <</s�'u �r �fz r-- z_>--,- z �-/ <br /> CONTRACTOg ADDRESS ZIP CONTR.LICENSE# �� <br /> ��/����r�- Jy�Fy`j�5rr�: « ��rC 2,��-%��,ri:�t_�i-r �=,�Gf�NSs��/� <br /> PHONE — ! <br /> i� z ; -Z5'j- Z�G � � <br /> PROPOSED USE OF BUILDING 8uilding Mechanical Addition HEAT SOURCE <br /> PERMIT Combinalion Plumbing WORK Alteration Electnc <br /> I �' / TYPE � Demolilion � Sign TYPE Nevr � Gas <br /> L -7��%/�� ���0 << � U Sprinkler RepairiMamc Omer <br /> CONTRACT PRICE OF WORK CITY OF EVEREIT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION '�I <br /> . _.',� .; �; /% jl-:� ;/,;✓/C / LCI'!i / /1�'9�'r� L''.k"/-irr 57� f—:i:� �, <br /> �� I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM i <br /> WATER CLOSET(TOILET) AJC—A/HANDLING UNITS <br /> BATHTUB _� FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER � UNIT HEATERS i <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER j <br /> DISHWASHER _ RANGE HOOD <br /> �I LAUNDRY TRAY _ WATFR HEATER � <br /> j CLOTHES WASHER _ METAL FIREPLACE,�STOVE <br /> URINAL _ FIREPLACE INSERT I <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> i BACKFLOV�' PREVENTER GAS PIPING � <br /> j � SINK (SERVICE/BAR/MOPlETC.) � EXHAUST FAN <br /> � OTHER _ OTHER <br /> I — <br /> � — -- — <br /> I — — <br /> i <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXA6IINED THIS APPLICATION AND KNOW THE SA6fE TO BE TRUE AND CORRECT. ALL <br /> i PROVISIONS OF LAWS AND ORIDWACES GOVERMNG THIS TYPE CF WORK WILL BE COtdPLIED 4VITH 11'HETHER SPEGFIED HEREIN OR <br /> '� NOT. THE GRANTING OF A PERM1IIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> �' STATE OR LOCA!LAW REGCLATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM FUTHORIZED BY THE <br /> I OWNER OF THIS PROPERTY TO PERFORA7 THE WORK FOR WHICH APPIICATION IS MADc AND I COMPLY WI fH THE STATE <br /> CON4RACT S�LAW 18.27�GW AND 290.200 WAC. <br /> , l� '� //�//� . �- � �-� /--C%� � <br /> Signatur— e�ner/ContractodAuthonzed Agent Date ! <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />