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_ i <br /> � <br /> P�r2MIT APPLICATI�J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET. EI�ERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 _ � <br /> ('y bo 2$ O'902 OD� C}�/rJ0 <br /> SITE ADDRESS � PARCEL TAX I.D.# ERMIT# <br /> 23� �r�v� We oZ28o4 •3 -Ob► " aooc , a�(o <br /> LEGA LOT N0. BLOCK TP.ACT <br /> DESC. ��ya� � r''� �y-►., Ne, g91o2SSo� o <br /> OWNER ADDRESS ZIP PHONE <br /> 1n�'Y'acc,r� �eal �►�c. Z�JOS �Z.''1°IPNe ��}le q$122 U�� 728 gs6 �, <br /> TENANT NAME CONTACT F4R P RMIT PHONE � <br /> {�anc�F�c Cc�as�' (�'1�1r�rve.. M�c1�+a�1 /��nslc i <br /> A,�s�.�„ A � , � ��. 4� l • � 2 <br /> CONTRACTOR � ADDRES� ZIP CONTR.LICENSE M <br /> � c co+�s-�r'.,�fi�an ln� . 2t�-os - Z��n►� Sr_,�1�)1�- Ss�2z <br /> PHONE��6 „1 Z Q 45'6 d � <br /> �Lai <br /> PROPOSEG U5E OF BUILDING }4J BUilding f� MBchaniC81 n Addition HEAT SOURCE <br /> yy�.���Gl.�, � ,,,w PFRMIT �K Combination F:� Plumbing WORK k_� Alteratlon � Electric <br /> � �F" �� `"� TVPE u Demolition U Sign 7YPe p�� New Gas <br /> � L� Sprinkler U RepatdMaint Other <br /> � CONTRACT PRICE OF WORK I � 2�p M l I� 1 �� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCR(PTION yy� a�Q S,'� Q qI1?OIE <br /> NCW '�'11�"t1� CeY1cYa�- �tiL�fn��+ca r3o F a�����C�D1S1� ' .l <br /> • 300 D � T SCcb r)A� s I�'y T7 i �/ / <br /> /._Q� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM NO. . TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) _ AJC–AIHANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ R.4NGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTI-IES WASHER N:ETAL FIREPLACE/STOVE <br /> URINAL F'IREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN _ G,AS RANGE <br /> 6ACKFLOW PREVENI"ER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ _ OTHER <br /> — <br /> —1 <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO 8,=TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH W HETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE Of:CANCEL 7HE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF PROPERTY ERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE I <br /> CONTR OR LAW'I8. W ND 29 0 WAC. <br /> . 8�3� d Q� <br /> Si nature of OwnedContractodAuthonzed gent Date �L <br /> D IT& CREDIT CARDS ARE NOT ACCEPTED <br />