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P�RMIT APPLICATIGIV <br /> CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE A�DRESS PARCEL TAX I.D.# 3°`y � PERMIT# � <br /> � :� �,�,/`� v .3�,G 3�=� 7G � — U�'� <br /> LEGAL LOTNO. BLOCK TRACT —�/ � <br /> DESC. � ] � �•P � � (i ✓P I � <br /> ✓� <br /> OWNER DDRESS ZIP PNON <br /> ���rN�r� ,��-�G: �90.� /r70�'�. ��.c1, �.�,u.�rr�a�_n Gc.� �,Sv3� ��5� 7fs-a�3� <br /> TENANT NAME CONTACT FOR PERMIT� � PHONE <br /> �r,�'cy L'.��tia,cL,e (a��) �.s��-��'d �� <br /> CONTRACTOR ADDRESS 21P CONTR.LICENSpE I# �l <br /> L��IQI�`� ��O IC-i <br /> � <br /> PHONE `,�M�E �3 l_.t.1-7�►:—� ��•-J ` N`� (�Q / •.1 H <br /> PROPOSED USE nF BUILDING Building � Mechanical Addition HEAT SOURCE <br /> PERMIT � Comhination Plumbing WORK � Alteration � Electric <br /> ��n � TYPE Demolition Sign TYPE New Gas <br /> K I Spfinkler Repair/Mainl. Other <br /> CONTRACT PRICE OF WORK CIiY^F EVERETT LOCAL SA�ES TAX CODE IS 3'105 <br /> WORK DESCRIPTION�/�'�� �'C��Cn — ���n',� l�-,nJ� �, , s��.�� <br /> � J'J (i 7`r p`- <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 /> KITCFiEN SINK 8 DISPOSAL �_ CLOTHES DRYER <br /> _ / DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> � _ URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER ,� GAS PIPING <br /> SINK (SERVICElBAR/MOP/ETC.) �_ EXHAUST FAN <br /> OTHER OTNER <br /> I HEREOY CERITIFY THAT I HAVE READ AND EY.F MINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AIJD C0�'tRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNItJ,THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIr.D HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIV[AU�iHORITY TO VIOLATE OR CANCEL THE PROVISION CF ANY OTHEP. <br /> STATE OR LCCAL LAW REGULATING CONSTRUCiION OR THE F'ERFORMANCE OF CONSTRUCTION. TI1AT I AM AUTHORIZE'D BY TiiE <br /> OWNER OF THIS PROPERTY TO PFRFORM1I THE N'ORK FOR WHICH APPLIf,qTION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRA��RS LAW 18.�R W AND 296.20q WAC. <br /> / � <br /> �-r.� � , °� /G U <br /> Signal of edContrect d ut orized Ayent Date �� - I <br /> V/ / <br /> DEBIT & CREDIT CARDE ARE NOT ACCEPTED �dl/ <br />