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!. . <br /> PERMIT APPLICATION �'6 $ �'' <br /> $a�.;o� - 03� <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.A P RMIT t <br /> ��4�� ��J'� �CV'� �a�' 'F�!'�dy ��{��-�7� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> ONMER ADDRE33 nP PHONE �.� <br /> bU.sa�a-�t k �N�LoPMct-�"(" p�O .P�Gx l05"I �"Ko{tGT'U4sH� WAr `182f l 33't9�18 <br /> TENANT NAME CONTACT FOR PERMIT PHONE ��,�' <br /> JEtV�I-� � b�t��S I�NDp-� b�W��-' , Go.PCR�ctJ6�Q�,{(C��iS � 801-1 <br /> CONTRACTOR ADDRESS ZIP CONTR.LJCENSEi <br /> P�,y�- W��t' �a-P. P•O.� ?n5`l-.�' AQUh1GT01y `(9223 Pu(z%(-w Gl Y�l k� <br /> PHONE �ZS Z `O -I��� <br /> PROP03ED USE OF BUILDING Building I"') M.�chanical I Addition I NEAT SOURCE <br /> ��r�2� yy�f,p�.�1F/�(�qj2- I PERMIT Combination H Plumbing WORK R�j Alteration Elactdc <br /> i• S�t�(,�S TYPE �Demolition IJ Sign 7YPE u New �Gas <br /> L) Sprinkler U RepairlMaint. LJ OTher <br /> CONTRACT PWCE OF WORK zo1�� — CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br /> NfORKDE3CRIPTION '��ty�ET �C"''((�Q-0V�{��� <br /> PLUMBIN.G MECHANICAL <br /> NO. ! IYPE OF FIXTURE OR ITEIN NO. TYPE OF FI%TURE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNI'T� <br /> � BATHTUB ^ FORCEDAIRSYSTEMS <br /> __�VATORY(WASH BASIN) HEAT PUMP =�' <br /> �Otq�� � UNIT HF:ATERS <br /> KITC�i EN SINK& JISPOSAL� OTHES DRY/FR/ <br /> -- DISHWP�SHER RA E H009 <br /> LAUNDRYJRAY � = WAT H ER <br /> CLOTHES N/ASHEF'-' METAL EPLACE/STOVE <br /> URINAL � FIREP� INSERT . <br /> _ DRINKING FOUNTAIN = GA�S'�IREP CE <br /> FLOOR DRAIN \ CKS RANGE <br /> BACKFLOW PREVENT�R S PIPING <br /> -� SINK(SERVICEIBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER_ �� _ OTHER <br /> �\ — - <br /> \ — <br /> I HEREBY CERITIFY THAT I HAVE READ PND EXAMINED TH�S APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACE;:GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH NMETHER SPECIFIED HEREIN OR <br /> NOT. THE GR4NTING OF A PERMIT DOEt�NOT PRESUME TO GIVE AUTHORITY TO VIOUITE 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 PRUPERTY TO PERFORM THE VYORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CO RA S W 18.27 RCW AND 296.200 WAi',. ^ <br /> �' I_✓ ' V� �'` � <br /> Sig ure nedContractor/Authonzed Agent Date ���j <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> ZG�'8� <br />