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P�RMIT APPLICATI� <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.# PERMiT# <br /> 1 i �l 9 l`l�fl�'� SE� 6 loo L � r� -0/3 <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 5 �cs�� ; /Q-i�1 q I3�u�e �-/c�-ri�1���� 2�6-�ZE-o9'yo <br /> CONTR�T NCO�� p�tC� SC��'(CPi ADGI C'D rz`�A U �J, ZIP CONTR.LICdUp yg ` <br /> � �Ty� LJ�9. ��'ins- RTN �D <br /> PHONE � 'L� " I e� <br /> �06-� z��r>qyo <br /> PROP6�ED USE OF BUILDING Building fR� Mechanical Addition HEAT SOURCE <br /> PERMIT g Combination H PlUmbing WORK � Alteration � Electric <br /> TYPE D Demolition Ll Sign TYPE New Gas <br /> U Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK � 5O(' � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION �/�S�GC.�a-+fdll PY�o ���ew 1 'f �� S�'(� S '�'(a� S�'''`�`eG�'� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHEB DRYER '� <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER I <br /> CLOTHES WASHER METAL FIREPLACE/STOVE I <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRA!N GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> II = SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN �,�Sie� j i� Ra��Yt'-� <br /> OTHER _� OTHER F�� S`�� <br /> I <br /> I I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � PROVISIONS OF LA4NS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERM1IIT DOFS NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL L4W REGULATItJG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO Pi=RFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> co��rouY�.z��wg � s a wnc. ��Z�� <br /> �� `� <br /> .� - _ " <br /> Signature of OwnedCoNractodAuthorized Agent Date <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED \�� <br />