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� PERMIT APPLICATIU�1 <br /> i CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI7 tt <br /> s� ,� �>� �l- �:�, ��i c;; i c c, � c:r,`i F3 a3ro �aat�� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. Z <br /> OWNER ADDRESS ZIP PHONE <br /> ;.zo y'rt= �� . s�, q���c:� 4�s-.zs�i-s�.iG, <br /> ��_�����c� �u,��e� ;ac� -'7i9-/i���yc�ll <br /> TENANT NAME CON7ACT FOR PERMIT PHONE <br /> [ ) � � F.r ��•lx' �•�-t�. . 5 '1 �J�1� ` �� �� <br /> X�..,e_ u c��i.�x- � b...���;n :� �5, �, S 33'7-�5�3�,� <br /> CONTRACTOR ADDRESS ZIP CQNTR.LICENSE# <br /> �je✓� J"`��1-i I I Izl� �f�� ���.e,���� ��,:5+ �f.r.7u�� C.(.CSToJ�A o35/�L� <br /> PHONE ��.2.5-�3�7-SZ.'��`I oJ- �I.�.S- �y — 7�I.2 Cc'II <br /> PkOPOSED USE OF BUILDING Building fl Mechanical Addition HEAT SOURCE <br /> � PERMIT Combination �-� Plumbing WORK Alteration Q Electric <br /> 5�,n���E_ 1"<i". �,� 1Lc- >.c�z�t� TYPE Demolition �--� <br /> LJ Sign ITYPE New �j Gas <br /> Sprinkler RepairlMaint. U Olher <br /> CONTRACT PRICE OF WORK � J i' CITY OF EVERETf LOCAL SALES TAX CODE IS 9105 <br /> ` 1 � I/ i �/ � <br /> WORKUESCRIPTIOD7 `�.yk•l �\. tA�.1r.AP�r�` p'� �v-�c:.` C�tr_�i� L.�_:v.c_c �i��� �L�i� �� 7�'`t����\:.]c.:_ \ , <br /> J J <br />� ! 4L+tSSfslNG MECHANICAL <br /> i <br /> ' N b fJ,, 7�t t}�.7�++1K 4N If€�ni NO. TYPE OF FIXTURE OR ITeM <br /> �� �f < <xt@!�~�{ �� i ;i��^ , � w� A/HANL�IINGUNITS <br /> 2,+�,af6 s i C� � �� LD Ai�i SYSTEMS <br /> '' � �i!'cr , ��;;,�vVli��iYa�aaH1 � N�r�,T f i t�,"„ <br /> `=ki:�1; ii --I IJ^',i HcA�EKS <br /> � � i t'Y? Ll?�1`iIt9K 8 l7'til�?(��;+yl, � _.�f [`i n7HF3 Df:`i f=i� <br /> �IER y � kAhl�E NC�OD <br /> �-_`� � ^ Wl�i'.r2 H�ATFR <br /> . .';a+t;k I NEIALFIREPLPCE/STOVE <br /> URINAL FIRC-^WGr. W�ERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOP,DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CcRITIFY THAT I HAVE READ AND EXAMINED'iHIS APPLIGATIGN ANU RNOW THE SAME Tp pE TRUF.AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPUFD WITii WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIV[AUTHORI i i�:VIOLATG QF: CANCEL THE Pf20VISICN Or ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFQRMaNrF oF r,ONSTRUCTION. THAT I AM AUTI fORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE 4ND I COMPLY WITN THE STATE <br /> CO P.ACTORS LAW 10.27 RCW AND 296.2C0 WAC. <br /> � � <br /> <.�«-�` � J ( �E. .�.� t:��,L `,:�z-l� �o -.� -c�� <br /> Signature of OwnedContractodA thonzed Agent Date �/� <br /> L <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />