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P RMIT APPLICATIUN <br /> ClTY OF EVERETT PERMIT SERVICES ����� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 � <br /> SITE ADDRESS �":� '�^ I !� ,i �i, � � `;i PARCEL TAX I.D.# FERMiT# <br /> (�_wc:-=�;«�__.p.,._z--�-i' �( dccpg - OU3 <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER / ADDRESS ZIP PHONE <br /> 7r�j(`�. C.cr� rlt.�.� �5'�ri� E 2Sc �� 5tce,.ol i{ �� ClE•1�Z \. Z � U – 7Z.f�'..t�5 L. <br /> TENANT NAME CONTACT FOR PERMIT PHONE (' <br /> �L4tw.�..y \7`f\ts . � � ,�v�('ir\Llc,7 l. ��nn���� 7'� 3' C�'?��� '.fl� �t:�.l� <br /> ) � — <br /> CONTRACTOR �``�11� ` ,(,����r� �� 1 ADDRESS L�Z �7 ��c�:�, Vc.I�t.� N..y.dlP CONTR.LICENSE# ��' <br /> ��Oc1 aU-�h�' �� 3 <br /> PHONE 2��7 ' �:yY�_9�E'.' /��.V�.rv�� ��"A �{IF��ba <br /> PROPOSEU USE OF BUILDING – Building Mechanical Addition HEAT SOURCE <br /> A,-1��< <` P� ,, ,� �, � PERMIT R Combinalion lumbing WORK �Alteration �lectnc <br /> �' 7 � Y TYPE D Demolition Sign TYPE New Gas <br /> —�n.-'. � . . <br /> U Sprinkle� Repair/Maint. Other <br /> CONTRACT PRICE OF ORK 2. �S� q 4 7 c�" CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION ,�.va�.�� C.'•�� iJ'�p'�,,.,� 1� S VLCw �-�vi�. �}-- {�cqperi, <br /> � ✓�S� c:�•� ��OC' � c, { 'Zr� U...'0..�v rd :'Y ��Lt1 U'�ri �'4�\C� � �C fnu�- c�.r�.:��.tS� <br /> 1 <br /> r , � <br /> �1n � � .� -z., � ,�„ble_ C 6���_k V�. �� . <br /> PLUMBING MECHANICAL <br /> NO. T"�E 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 /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER S UNtT HEATERS <br /> KITCHEN SINK& DISPOSA� � CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> I BACKFLOW PREVGNTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> �(}�.y OTHER�'� ��--1 �� r�'.�S _ OTHER <br /> ib�,,,, �� ti�,,,� �..=. .�.,.��: r'f�''^�, — — <br /> — i <br /> — <br /> — � <br /> I I HEP,EBY CERITIFV THAT� HAVE READ AND EXAIdWED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF LAWS AND ORIDINACES GOVERNING 7HIS TYPE OF INORK WILL BE COPAPLIED WITH WHETHER SPECIFIeD HEREIN OR I <br /> � NOT. THE GRHNTING OF A PERMIT DOES NOT PRESUA7E TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> I' STATE OR LOCAL LAW RE�ING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE � <br /> OWNER OF THIS PR 2RTY�0 PERFORM THE W K FpR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS 1827 AND296.20 j� <br /> �� / /i�� �% � �t- I S% -o (� <br /> SignBtur of Q�nerT n�r ctof/Authori ed Age}r Y' Dale � <br /> i// DEBIf�& CREDIT CARDS ARE NOT ACCEPTED L <br />