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���G �/ <br /> P�MIT APPLICATIO� <br /> GITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS <br /> PARCEL TAX I.D.# PER IT k <br /> /l`l `l -l9 �ftti'� .S C' . �G1 � <br /> LEGA LOT N0. BLO�K TRACT `�//G-�33 <br /> DESC. <br /> OWNER �S�IJ�(C ln�K� !cq-2A <br /> ADDRESS ZIP PHONE <br /> - '- n/Bi�o�'-� � , C'Y£iC�IT. 4kzo� 4LS,;35 , �b �b' <br /> ��OAS� /�Elj"L �:S l �'I"'C ��/o � PHONE <br /> TENANTNAME CONTACTNAME <br /> SUSI I Rl,vCti 1=J�,�n1k �vo;Jz,<Yl.c:-S �l�s• 3� �. 3'� �0 <br /> CONTRACTOR <br /> ADDRESS ZIP CONTR.LICENSE H <br /> i�l:9TS/�i✓jC12�'I C CS ���/� �°%7�2C `C'Vr�:s� �)ti^,'.J �lrZ3� �5/51.3 � !`1 � i"Q <br /> PHONE /1?/LL C/�'.E�=��� 6/�� . �l[FO/1 <br /> �/IJ. }'�U .��Gc� <br /> Building Mechanical Adtlition HEAT SOURCE <br /> PROPOSED USE OF BUILOING Electric <br /> PERMIT � Combinalion �Plumbing WORK Alteration R Gas <br /> �7 TYPE Demolition Sign TYPE New {_( <br /> /t� 1-TL'2��'-�� Sprinkler RepaidMainl. L7 Other <br /> � -=� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> CONTRACT PRICE OF WORK � �� — <br /> WORKDESCFIPTION=��>T�Z.` �,,`f S%! slE•.A:� %/�f/����� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM � <br /> NO. TYPE OF FIXTURE OR�TEM <br /> WATER CLOSET � _. A/C–NHANDLING UNITS <br /> I BATHTU� _ FORCED AIR SYSTEMS <br /> i _ LAVATORY(WASH BASIN) = HEAT PUMP <br /> I = SHOWER — UNIT HEATERS <br /> KITCHEN SINK& DISPOS CLOTHES DRYER <br /> DISHWASHER T, _ RANGE HO <br /> � LAUNDRY TRAY J _ WATER H �R <br /> � CLOTHES WA`E _ METAL FIR P EiSTOVE <br /> I URINAL - � _ FIREPLACE ERT <br /> I = DRINKING FOUN� = GAS FIREP ACE <br /> FLOOR DRAIN GAS RA E <br /> BACKF�OW P� VENTER GAS PI NG <br /> I SINK (SERV�{CE/BAFUMOP/ETC.) OTHERST FAN <br /> OTHER — <br /> I HE.?EBY CEPITIFY THAT I HAVE READ AND EXAMINED THIS nPPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. Ai.L <br /> pqOVISIONS OF LAWS PND ORIDINACES GOVERNING THIS TlPE OF WORK WILL BE COMPLIED WITH WHEiHER SPECIFIED HEREIN OF <br /> ST�ATE OR GOCAL ILAW REGULATING CONS RUCT ON OR THOE P RFORMANCE OF CONSTRUOCT OtJ. THAT I AM UTHIORI ED B'!HE ER <br /> OWNER OF THIS PFOPERTY PERFORM THE WORK FOfi WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.2 , �;AND 296200 WAC. <br /> / <br /> � /t, 2 w c-' <br /> Signalure of Owner C fitractodAuthorized Agent ' Date' <br /> 1 <br /> � <br />