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. � ( ( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 �� �6� - �v <br /> SITE ADDRESS PARCEL TAX I.D.ri ERMIT <br /> 1ot17 Iq�+,{VE. S.E., EVC�TT 982b$ 00575500bO�ZOU � �j(�S- �-,Z <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. 't q 5av �� V��� <br /> OWNER AUDRESS LP PHONE <br /> aR.SHWQMI YANA6�� Z8N-�L{�lby A1ENuE �y�r hlA. 98?DI N25'-25`I-9145 <br /> TENANTlIAME CONTACTFORPERMIT PHONE <br /> f��U�,�SCZi�1¢�l �Y2;S'•3S0-848y <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSEi <br /> NHONE ����'-��/ <br /> PROPOSED USE OF BUILDING Btlildiflg � Mechanical Addi�ion I HEAT SOURCE <br /> �V �u���L O�,n�., PtRM1T � Cort7binati0n Pl9mbing WORK � Alteratian � EleUric <br /> A flw/ R�G rypE Dert101il'10� SI 0 TYPE New Gas <br /> Sprinkler Repalr/Maint. Olher <br /> CONTRACT PRICE Of WORK ��,r� ,y;q�oN CIN OF EVERETT LOCAL SALES TAX CODE IS 3106 <br /> WORK DESCRIPTION 62�Y�IO� CEN'�t� s»RY oPP[CE �WtAtNIE. C'S�'i�I'IW�1 SU�TG,� � <br /> G��BAMK�.ND (y)►Meqc� oFH� ��.%�rt�s. <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FI%TURE ORlTEM N0. TYPE OF FIXTURE OR ITEM <br /> f� WATER CLOSET Z A/C-AIHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> fQ_ LAVATORY(WASH 6ASIN) ,�_ HEAT PUMP <br /> SHOWER � UNIT HEATERS <br /> — K�TCHEN SINK&DISPOSAL _J_, 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 FIREFLACE <br /> FLOOR�RAIN -+ GAS RANGE <br /> BACKFLOW PREVENTER -� GAS P�PING <br /> � SINK(SERVICE/BARIMOP/ETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL B[COMPLIED NATH 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 I AM AUTHORIZED BY THE <br /> OWNER OF 7HI5 PROPERTY TO PERF M THE IVORK FOR WHICH APPLICATION IS MADE AND�COMPLY WITH THE STATE <br /> CONTRAG7 LAW 78,2LRCW AN 96200 WAC. <br /> / (�/ <br /> `—,/�j✓ ,� i S�-��--lc���'7` <br /> Signature of O o C tr or uthori d Agent Date � <br /> DEBIT 8 CREDIT CARDS ARE NOY ACCEPTED L <br />