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( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEREI7, WA 98201 <br /> I � 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT/ � <br /> ��7�b5 �b`�^ �{Z Sc N10�-loco -oui <br /> LEGAL LGTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS 21P PHONE <br /> L�L t <br /> �;�4..,... (�.�,c.�u.,0.n l o�� oS 2e�^^ t��s� 9d'lcfC 3J7 — 7gyo <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �SA w..� �Ccv i nl rV1�l.eo�Q � �SS3�' <br /> CONTRACTOR Wash� n��a ���.�jny ADDRF.SS �36 z Z IS�JC S. ZIP CONTR.LICENSE# <br /> Qvl� f��� �/ <br /> PHO E SN/i 41� (�(J /T Wf'�S�IT7IRC I Z...LQ <br /> �2�� S(,o- 383z <br /> t�ROPOSEDUSEOFF.�ILDING Bi�ildin Mechanical n Adtlition HE4.TSOURCE <br /> I n, t� PERMI7 R Cornbination � Plumbing WORK �f Nteration � Electnc <br /> �"��' TYPE Demoliti0n i� Sign TYPE R New Gas <br /> B Sprinkler IJ Repair/Main; Other <br /> CONTRACT PRICE GF WOR 7 i1OO CJQ CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> ��i , <br /> WORK DESCRIPTION L��� ♦ 'L� ��S �n ,f.� Q �-� /��� Fl Q� h�j. <br /> (1 �.r �..�_ C:l' <br /> / <br /> I�G W C-�vr{S �u ienQ Ge.-i- (�Jct.�-�r�z. /�.�•`�c-2 <br /> Q.< lau. olc� El�c,4R.ic. yil.e, a � wr.�c✓ �ca'f.,c <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _� WATERCLOSET(TOILET) A/C-A/HANDLINGUNITS <br /> BATHTUB I � FORCED AIR SYSTEMS <br /> :.AVATORY(WASH BASIN) HEAT PUMP <br /> Sr�OWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY I � WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREFLACE INSERT <br /> DRINKING FOUNTAIN GNS FIREPLACE <br /> FLJOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER � GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXPMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CnRRECT. ALL <br /> I PRO`✓ISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF',VORK WILL BE COMPUED WITH WHETHER SPECIFIFD HEREI�J OR <br /> NOT. THE GRANTING OP A PERMII'DOES NOT PRESUME TO GIVE AViHORITY�i O VIOLATE OR CANCEL THE PROVISIOP; �:.` 4�lY:1THER <br /> ' STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFJRMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 9Y THE <br /> OWNER OF THIS PR RFORM THE WORK FOR WnICH A�PLICA?!,^.iv IS MADE PND I COMPLY WITH THE ST.+��TE <br /> CONTRACT��J . CW AND 296. .-- <br /> ,= � - / -�� <br /> ignature of OwneriContractodAuthonzed Agent Date <br /> GEBIT & CFtEr17' CARDS ARE NOT ACCEPTED � <br />