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�- P4tRMIT AP�LICATI(��V � <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257- S10- FAX 425-257-8857 <br /> �� I <br /> SITE ADDRESS ,� PARCEL TAX I.D.# PERMiT x <br /> � . . . /i n: � l�� �/� . -� � ;cir1 [�,c;1 _ ���`LC�a�-p� <br /> LEGAL LOT NO. BLOC� ACT 7� <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> ���¢'iZ �l'�)r�J� -T.��.: • -in�cr�7s� �t RcK rc �`'i 5•r71 N 9�5?`1 ! <br /> TENANTNAM , CONTACTFORPERMIT PHONE <br /> � ����� ��i�<� ���� <br /> CONTRACTOR ADDRESS ' ZIP CONTR.LICENSE# <br /> Np�Li"7{ t..;.a i ?Ic�,�.�j��.� 1 <br /> PHONE � � �� �G� �nS <br /> �L� G�s3 7Zz-y 3.Sio 1�.6�1,. �! 1�'i= i Z3 95z`3 /uoi �'HPcoti�'X�3 <br /> PROPOSED USE OF BUILDING Buildinc� Mechanical Addition HEAT SOURCE <br /> PERh11T R Combination Plumbing WORK �Ileration � Electric <br /> TYPE g Demolition �Sign TYPE New Gas <br /> �> ` Sprinkler RepaidMainL Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> WORK DESCRIPTION ���, <br /> ��UY11LJ7Y��1 /"�cS� �tC,L•{'v\ f� �ii C uil�V` Ch -5 ` <br /> PLUMBINCs MECHANICAL � <br /> NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM — <br /> � WATER �LOSET (TOILET) _ A/C–A/HANDLINGUNITS �` <br /> BATHTUB FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _I KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RAPJGE HOOD <br /> LAUNDRYTRAY � WATERI�EATER <br /> � CLOTHES WASHER _ METAL FIREPIACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING �OUNTAIN GAS FIREPLACE <br /> + FLOOR DRAIN _ GAS RANGE <br /> I BACKFLOSV PREVENTER GAS FIPING <br /> f SINK (SE�RVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> � OTHER OTHER <br /> � e'�-c S ' S — <br /> I HEREBY CERITir'Y THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOLV THE SAME TO BE TRUE AND CORRECT. ALL <br /> �' PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRAN7ING OF A PERMIT DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LA�l�REGULATING CONSTRUCTION OR THE PERFORIdANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br /> UWNER OF THIS PROPERTY TC PERFORId THE WORK FOR WHICH APPLICATION IS IvfADE AND I COMPLY WITH THE STATE <br /> CONTRACTOR$ LAW 18.27 RCW AND 29fi.200 WAC. <br /> / <br /> 'i�'� ����irj ��"' Z, L _"�% `{ <br /> SignaW e uf OwnedContractodAuthorized Agent Daie <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED � <br />