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� <br /> �ERMIT APPLICAT�t�N " <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-25%-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TA7C I.D.# PERMIT# <br /> � �3.�d C� GcJ• o o � 3 Ya� a�oc 2=��ro a o S� o -7��(� <br /> LEGA LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER AD���RESS ZIP PHONE <br /> /� n Q�,2 7S tfj,�?y-� 5�57 z <br /> a.�d �'L4..��� c�P�/LGL 5�t 3 01 3-�d GLct� � 7ry b�Lr' <br /> TENANT NAME CONTACT FOR PERMIT J� '��'�k PH�� 8176 <br /> Si4�rN� /11iLGCK�G-C�tJ, �`is,� �-tuG �/t� 23t - �733 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> /n��-C�-l� !�-av�u�+_?Co,,.t..,lti,� yZ�S- '1Ma.u� Sr�.u�.tr ��3 ���c�e a32�r <br /> PHONE llz� LSJ Fl�� (J Q. <br /> 7 /23�-n733 <br /> PROPOSED USE OF BUILDING uilding (� Mechanical Addition HEAT SOURCE <br /> PERMIT COmbinat(On � Plumbing WORK Alteretion D Eleciric <br /> S�� / 1'�e 'T 7�a TYPE Demolition Sign �E Re air/Maint. B Other <br /> Cuv�r Sprinkler P <br /> CONTRACT PRICE OF WORK `U�UUV �� CITY OF EVERETT LOCAL SpLES TAX COOE IS 3105 <br /> WORK DESCRIPTION <br /> �J�GCc- .�d-G'� �R�o-��.litvj�4-l� C�h�G[ .�jt ',�v-/' �l.��i— <br /> / � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO.. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ A1C-A/HANDLING UNITS <br /> BATHTUB __ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <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 <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE REAO AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PFiOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS.7YPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED B�THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTR TORS LAW 18.27 R W AND 296.200 WAC. <br /> lTs* 1 �r�c�— <br /> Signature Owned ontractorlAuthonzed Agent Date �/a <br /> DEBIT 8 CREDI7 CARDS ARE NOT ACCEPTED J <br />