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t ERMI� APPLICATiJN <br /> CITY OF EVERETT PERMI i SERVICES <br /> 3200 CEDAR STREET, EVERETT', WA 98201 <br /> 425-257-8810- FAX 425-257-8857 CI .-4.�0 3 <br /> S�TE ADDRESS PARCEL TAX I.D.S P RMIT a <br /> �� 70 `/ ,1,5 �i '.' o3anno HoSon � 3O -p <br /> LEGA L07N0. BLOCK TRACT <br /> DESC. <br /> OWNER l�D�RESS LP PHONc' <br /> w' /N� �'�C��'���1��/,� � 70� �s�s: ry�zo� y��- .�sa y��� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> �iSZU//��S $'��U/G C S �/,�6r S/-�a✓r�� I <br /> CONTRACTOR �/,1U/US S f/�G�� E�'S ADDRESS /�/OC� f/T1j /JL����l�# 7JP CONTR.LICENSE 8 <br /> �' oAu�vs�r o 1�o�/ <br /> PHONE � �.� �— �!ly D �^.�.z y�.2d�� <br /> PROPOSED USE OF BUILDING Building f'� Mechanical Adtlitlon HEAT:'OURCE <br /> PERMIT Combine�i0n �_� Plumbing WORK Alteration R Electric <br /> E, TYPE Dem0lition LJ Sign 7YpE � New �j Ges <br /> C� R�� ��� Sprink!er RepaidMaint. U Other <br /> CONTRACT PHICE OF WORK (1� � �U qTY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> / <br /> WORKOESCRIPTION � �� n��� �DO S,F, <br /> /S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FlXTURE OR REM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _ K�TCHEN SINK 8 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 /> I = SINK(SERVICE/BAR/MOP/ETC.) = EXHAUST FAN <br /> OTHER OTHER <br /> � — — — <br /> i <br /> � — — - <br /> i — — <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING TIi15 TYPE 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 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOR THE WORK FUR WHICH APPLICATION IS hIADE AND I COMPLY WITH THE STATE <br /> CONTRACTD �.27 RCW AND 29 . 00 WAC. <br /> � � ,�_`� � � GL' f.�-(.j� .�` �C " G�� <br /> Signat re oT OwnedCoNrac�odAuthonzed Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED I /1' <br />