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i <br /> P�RMIT AF � LICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERFTT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> �l0 3 <br /> SITE ADDR[SS PARCEL TAX I.D.# P RMIT# � <br /> //`�/ —/ ""'.�✓�S,E'. ���-�S <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER AD�RESS ZIP PHONE <br /> �D�14�u�]��..r� C�' {70B�- o �_ 4 Z-S'��4-� <br /> �4ouo.,�sr� 98291 <br /> '[�IAN��O EL M�� J CONTACT FOR PERMIT pHONE <br /> �s t� <br /> ��ruRc_cw-_��J �?e.aD 5-�,�Ru+�C.Se,J 4'zs-Z+S�-Go4�• <br /> C�Nu�.CCTO,�Ij ,�,���MxQ J ADDRESS ZIP CONTR. LICENSE# <br /> 1� �t pe�nssss 98ZLS <br /> PHONE��S•�JO'�6� <br /> PROPOSED USE OP BUILDING I r!r!r!JJJ���BUilding I"") MeChanical Addilion HEAT SOURCE <br /> • PERPAIT �Combination �-� Plumbing WORK R Alteration Pj Electric <br /> TYPE Demolition L.j Sign TYPE D New D Gas <br /> Sprinkler U Repair/Maint. D Other <br /> CONTRACT PRICE OF WOR A �D�' CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> �7 <br /> WORK DESCRIPTION <br /> _T:'�-s..---Z' ��-.pne.ae.r�.�.�.,t �ulw�►+� C. uu. r (b'3 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A1C-A/HANDLING UNITS <br /> BATH i UB FORCED.11R SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK E DISPOSAL CLOTHES DRl'ER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTF:cS WHSHER McTAL FIREPLACE/STOVE <br /> URINAL FIREPL?,CE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLAC[ <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 I HEREBY CERITIFY THA71 HAV�READ AND EW+MINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I PROVISIONS OF IAWS AND ORIDINACES GOVERNIN6 THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOiZITY TO l'IOLATE 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 APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RC AND 296.2 0 WAC. <br /> �;� /�.�.� � co-Z9-d�- <br /> ignature of Owner/ContrectoAAuthonzed Agent Date �/L <br /> � DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> I <br />