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� <br /> P'�RMIT APPLICATI�N <br /> CITY OF EVERETT �ERMIT SERVICES <br /> 3200 CEGAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- �AX 425-257-8857 <br /> I � � .� � , <br /> SITE ADDRESS PARCEL TAX I.D.# RM� I <br /> � �0 5T'�Av � W :� qo43t�cOy1�400 �, ��-� <br /> LEGAL LOT NO. BLOCK TRACT - --- <br /> DESG S � ���-% �C.� � U <br /> OWNER ADDRESS ZIP PHONE <br /> m, �, > �+f�er�, 3�31 wooc'tla�_L. or CGrnaYu111�1 wa 3bv 3B1 �03� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � YYInrIQ n c t� � ��1'��er� 3b 0 38"7 io0'�a <br /> CCNTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> ,oHNwC 10' M� I <br /> PHONE 3bC� 3�� 603� 3�� wooclir„�,cl Or� C.1 V.J°` ���c� <br /> PROFOSED USE OF BUILDING Building f"l Mechanical Addition HEATSOURCE <br /> PERMIT � Combinalion FZ� Plumb�rtg WORK R Alleration � Electnc <br /> TYPE Demolilion Lj Sign TYPE D New Gas <br /> S fr � Sprinkler U RepairlMaint. Olher <br /> CONTRACT PRIGE OF WORK CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION i <br /> � .��li���) �-���L�S.�, <br /> � �� � � � .� ����� <br /> PLUMBING ' MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 'Z- WATER CLGSET(TOILET) A!C-A/HANDLING UNITS <br /> �,_ BATHTl:B F'�RCED AIR SYSTEMS � /,;C��� <br /> 1 LAVATORY(WASH BASIN) _ HEAT PUMP c / � f"" � <br /> SHOWER UNITHEATERS �� Ort S�� <br /> 1 KITCHEN SINK& DISPt�SAL � CLOTHES DRYER f)c , �{�ir�` <br /> 1 DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY \ WATER HEATER <br /> 1 CLOTHES WASHER METAL FIREPL4CE/STOVE I <br /> URINA.L FIREPLACE INSERT <br /> DRINKING FQUNTAIN GAS FIREPLACF <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLUW PREVENTER \ GAS PIPING <br /> SINK(SERVICE/BAR/MOPIETC.) \ EXHAUST FAN <br /> OTHER OTHER <br /> I I HEREBY CERITIFY THAT 1 HAVE READ AND EXAPAINED THIS APPLICATION FND KNOW THE SAME TQ BE TRUE AND CORRECT. ALL II <br /> I ?ROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL 9E COh9PLIED WITH 4VHETHER SPECIFIED HEREIN OR <br /> INOT. THE GRANTING 0�A PERMIT DOES NO'. PRESUI�IE TO GIVE AUTHORITY TO VIOLATE OR CP.NCEL THE PROVISION OF ANY OTHER � <br /> ISTATE OR LOCAL LAW REGULATING CONSTRUCI'ION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THF_ <br /> OWNER OF iHIS PROPERTY TO PERFORM THE WORK FOR WHICH APFLICATION IS MADE AND I COMPLY 1NITH THE STATE <br /> ICONTRACTORS LAW 1827 RCW ANO 296'Z00 WAC. <br /> `m[i;�Q t h c L�� �� o n�l <br /> Signature of OwnedContrectodAuthorized Agent Date <br /> I DEBIT & CREDIT �ARDS ARE NOT ACCEPTED (I�� <br />