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r <br /> P�RM�T 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 �, PARCEL TAX I.D.# PERM'iT/# <br /> t li(� S� � Oc�57y ? oolof � �l �1 �� ' nn <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> //1t'11ZIUf�� Ca�c.oL i���c�l•I1L �n 1�6X iDi9 SIUO%/awt�s�. '-1ZS334 S'7�t S's _ <br /> TENANTNAME CnNTACTFORPERMIT PHONE <br /> CONTRACTOR ADORESS 21P CONTR.LICENSE tt <br /> �i/�2�7-f wLST l�l � rnbrn-g ,Vo�ZTkPcoSsKB <br /> PHONE <br /> 3bb 1�53 • 7ZZy ,3Ssln j6�il� P1 M� "`iL3 rifsZ23 <br /> PROPOSEO USE OF BUILDING BUilding [� MechaniCal Addihon HEAT SOURCE <br /> PERMIT R Combination �J Plumbing WORK R Alleratlon � Electric <br /> TYPE D Demolition U Sign TYPE C�l New Gas <br /> --- w��f, u Sprinkler �7 Repair/Maint. Olher <br /> CONTRACT PRICE OP WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> U I � cS'l p � ) . � <br /> PLUMBING MECHANIGAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> I WATER CLOSET(TOILET) AIC 'HANDLING UNITS <br /> BATHTUB FC. , : 7 AIR SYSTEMS <br /> l LAVATORY(WASH BASIN) 1�tA i ;'UMP <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER R.4NGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER 61ETAL FIREPIACE/Sl vVE <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 /> i — <br /> � I HEREBY CEFcITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEi: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 I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATIUN IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC ORS LAW 1827 RCW AND 296.200 WAC. <br /> ���'a� ��� /�✓�1 f 1 - 2 3 -0 � <br /> Signa ut re of OwnedContractodAuthorized Agent Date <br /> DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED I <br />