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I�ERMIT APPLICA1�rON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-881 U- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> p�_ O G s'7 4�700/o� 9 0`� Co 5L�{�r�Y <br /> LEGAL LOTNO. BLhOCK '/ TRACT � <br /> DESC. ����C/ '"07 � . 5�,���z d ��r��o��y,N�l�i�s,o�< <br /> OWNER ADURESS � ZIP PHONE <br /> �'� .��v� 1/st ic�.w /i!1$ �--'-�3�, />2 S.E �c��/�` 9'S zoSf <br /> TEN T NAME CONTACT FJR PERMIT PHONE <br /> �vt� c�� �/f!CG/�G I Y�l�- �37—�.5�7 <br /> CON ACTOR . ADDRESS ZIP CONTR.LICENSE# <br /> PHONE � <br /> PROPOSED USE OF BUILDING Building ChnnlCal Additlon HEAT SOURCE <br /> F�,v�s�j ,�j�j�l/fin/ PERMIT Combination • Pl��rr,uing WORK R Alteration �cuic � <br /> TYPE Demolition Sign TYPE D New Gas <br /> Sprinkler D RepaidMaint. Other <br /> � <br /> CONTRACT PRICE OF WORY. /Z�' /�D CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKD/�SCRIPTION �- /���� � ��j ��.q.� !/ SC�� �i �</��5 �'� `' " <br /> �o7 /� EBbiy�/��fl-� , v >`-l.C/�i �oosYJ STR�e �9�?e� <br /> � / T ,�f�v�-/� /�oOrJ 9� �.e C. /��o�. <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. . TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET(TOILET) A/C-AIHANDLING UNITS <br /> � BATHTUB _ FORCED AIR SYSTEMS <br /> 2 LAVATORY(WASH BASIN) HEAT PUMP <br /> �_ SHOWER _ UNIT HEATERS <br /> _L KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> _� DISHWASHER _ NGE HOOD V� S�-��s ��v <br /> LAUNDRY TRAY WATER HEATER <br /> � CLOTHES WASHER _ METAL FIREPLACE/STOVE G"��'e <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPIACE <br /> FLOOR DRAIN GAS RAfvuE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) �- EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERIT;FY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE 5AME TO BE TRUE AND CORREi:"- AlL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIE���F:REIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT FRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF Ai.!OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AP.9 AUTHORIZEG BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LA 18 27 CW AND 29 '00 WAC. <br /> Sig ure of wnedContrectodAuthorized gent �'/' Date `�Zj <br /> EBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />