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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS �' /G f$ ;� LI r��IJ i•ivL S� PARCEL TAX I.D.# PERMIT# <br /> k V4re.tt o 00 lo �' (' B03d5-cJ�-l.� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DE5C. � � �G� �� <br /> OWNER ADD ESS ZIP PHONE <br /> � /O$' ,3,��r``I� iV �. SF' <br /> � �1� � �� c.,.. �= t �1,rti,��;,... �, �/�f`c f-1- 44t�,n-� �I.1S- �SS-�SSI <br /> TFNANT NAME CONTACT FOR PERMIT PHONE <br /> W�. ���c, ,�. 1- ln�c��` i v�r. �I a.'� �t� -Z S SI <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> PHONE �(/`�'/�� (,/ _ <br /> 7`C', !� c J�e_tc�' iJli ��.e <br /> PROPOSED USE OF BUILDING Building f"') MeChanical Addition HEAT SOURCE <br /> PERMIT � Combination K Plumbing WORK � Altemtion � Electric <br /> 7YPE Demolition U Sign TYPE New Gas <br /> � Sprinkler RepatriFAaird. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> �'S. �; nc�, [�c� .� u ! � <br /> WORK DESCRIPTION <br /> fG �/��� c �v �'�c/ Sf �^ 9/'�iyL /'G Cl4c % S/ D< 0/� <br /> ��� � �G /�151����C < <br /> PLUMBING MECHANICAL <br /> NO. TYPE 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 /> LNVATORY(WASH 8,4SiN) HEAT PUMP <br /> SHOWER UNIT HEATERS <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 /> — /�r CIf r u< h��� E — iUr,t i!f' o�e..=�fyiac <br /> I HEREBY CERlTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE 9AME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS�ND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEU WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO Glb'E AUTHORITY TO VIOLATE OR CANCEL TFiE PROVISION OF ANY OTHER <br /> STATE OR LOCAL lFW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT�AM AUTHORIZE�BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR 1h'HICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 286.200 WAC. <br /> ���f' �. � <br /> � _ � �" �'2� '�Z <br /> Signature ofT')wner�%o rector/Aut ionzed Agen ate <br /> DEBIT 8 CREDIT CARDS Akt NOT ACCEPTED <br />