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� - <br /> � <br /> PERMlT APPLICAI ION <br /> CITY OF EVERETT PERMET SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAl( I.D.# 3�`� PERMIT# '7 <br /> G - . Y1E � / 30� <br /> %G '�,� .��'D� l."3Dn ;s�5s �?C) L'v �/ / - �'� � <br /> LEGAL LOT N0. BLOCK TRACT <br /> D�SC. � " �•P��`S �"2!3/'���v,i � CiIIV��I � <br /> OWNER ODRE55 21P PHON <br /> .�rsrH�ic-- �,/—,C: �YD� /�70�'� ��,c1 �..,Nti•.�z� GL� ���,�5� 7s�s-d�t3� � <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> _ I �P,�'E� (-,Hi�?N'G3�C,GiC (.�v�� �vSG-[��'d `� <br /> CONTRACTOR- A�ORESS . LIP CONTR. LICENSE ti <br /> •FXpi2�.`> �}IS�o'f <br /> FHONE j�� �g �'\ �� <br /> �.t.0 ��.�l{d I� q�y�' H <br /> PROPOSED USE O: BUILDING � Building � �vieChanIC31 � Addition HEAT SOURCE <br /> PERMIT Combination Plumbing WORK Alteration Electric <br /> ��„7 TYPE Demolilion Sign TYPE New � Gas <br /> � Sprinkler Repair/Mainl. Olher <br /> CONTRACT PRICE OF WORK GITY OF EVEREII'LOCAL SALES TAX CO�E IS 3105 <br /> I <br /> WORK DESCRIPTION Q l <br /> i��� ��/�- - .P�l!'i �.��`JiG' � ��`-�� <br /> PLUMI3ING 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 _L FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> 1_ KITCHEN SINK& DISPOSAL _L_ CLOTHES DRYER <br /> � DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY � WATER HEATER <br /> Z CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URRJAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN � GAS RANGE <br /> BACKFLOW PREVENTFR GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST rAN <br /> OTNER OTHER <br /> I NEREBY CERITIFY THAT I HAVE READ AND F�(Ati11NED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L4W5 AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL 6E COMPI_IED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANT,NG JF A PERMIT DOES NOT PP.ESUME TO GIVE AUTHORITY TO VIOLAT�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 Tj-IIS PROPERTY TO PERFORM THE WORI!FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONTRAC F25 LAW 18.27,,RC�/AND 296 20 NVAC. <br /> i � � <br /> % u.. 0 . �3 <br /> Signatyre of Qc er/ ontractor/Authorized Agent Date �/L <br /> / <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />