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� <br /> PERMIT APPLICATION �°3� <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT,WA 38201 <br /> 425-257-8810—FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N RMIT <br /> il4l� I�", Av� s-E !-� -/03 oo5lti 190(o I �o � D/ - oolo <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDREBS ZIP Pi1JNE¢ZS <br /> C%UJA1ZOlhl P2d�LOk��'�EI�"r t?o. gox �OS`I SN�tGr-��5{t Wb �IP>Zql 33� `=A�� <br /> TENANT NAME q-Z� CONTACT FOR PERMIT PHONE ��S <br /> �'t�v�' Y� t'1 zw.rn6� so,�c�l�o.- a��-- cs�prrnv�aG��C�C(s 3�1 ��rl <br /> CONTRACTOR (Jv(�,�( �/�/G�� ADDRE33 ZIP CONTR.LICENBE/ <br /> f.o. �c 3���5 af�l-�KC�v�k Wa �vc,�rwc c��k6 <br /> PHONE 1j bO • �S�J FiC����• cI�Z�J <br /> PROPOSEDUSEOFBUILDING BUlldi�g � Mechanical I Addition I HEATSOURCE <br /> I PERMIT B Combination Plumbing WORK B Atterstion D EleGric <br /> TYPE U Demolition Sign TYPE New U Gas <br /> U Sprinkler B RepaidMaiM. U ome� <br /> CONTRACT PRICE OF WORK [O .��O CITY OF EVEFIETT LOCAL SALES TA7(CODE IS 7706 <br /> WORK DE3CRIPTION <br /> TE.tiurt' I�p¢,�d�N: �o '1'1 L����3 <br /> 1_:2up oF'�' �p(GK �(° Of���( _ rl0 GL�N�bN.6 oN SCf� <br /> PLUMBING MECfiANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEN <br /> WATER(:LOSET A/C—A/HANDLING UNITS <br /> BAiHTUB FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY = WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACEISTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPIACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BARfMOPIETC.) _ EXHAUST fAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE REA�AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROV�SIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH NMETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTFIORIZED BY THE <br /> ONRJER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 CAMPLY WITH THE STATE <br /> CONTRAC 1 27 RCW AND 296200 WAC. <br /> � �,�(���i��' I� I`�� U� <br /> Signature of� ErlCont2dor/Authonzed Agent Date �i <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />