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� I'ERMIT APPLICAI �ON <br /> I CITY OF EVERETT PERMlT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 'n� �! / `�� I <br /> / <br /> SITE ADDRESS ,ry PARCEL AX I.D.# PERMIT» <br /> � <br /> GI�'�� �� /Z �- .� L�� Ov2��v l 3cv ��o C _��// -D �� <br /> LEGAL LOTNO. BLOCK TRACT <br /> oEs�. •z 3 � ✓G��t! c�z{ ,: G��.,,��'�,>r <br /> OWNER ADDRESS c' <br /> 1��=�� �E i � ZIP PHONE <br /> LJ, , / G I�,.� :�, 7..�r> <br /> l��h sc�ti's �o�,�i�=��1':�s Z'��t �.Ya . , �rZ j 772 -- ZoT� <br /> TENANTNAME CONTACTFORPERMI7 PHONE I <br /> /L»c%i0 ��r'/i!/ 1"�j o.%7 �jZ l 7 7Z - 2�5� <br /> CONTRqqq CTOR .--� ADDRESS �01 GiG 1l/ ZIP CONTR.LICENSE# <br /> �Y%l6�/f��'11 �d ry �taC i�ni �HC. . �/��� �`�`/ <br /> PHONE , �Y�6� f _ <br /> �� ��- �,� - ��s-b �, 62 �E�lDor« <br /> PROPOSED USE OF BU�LDING Building !� Mechanical Addition HEAT SOURCE <br /> , /� � � PER�d1T Combination �d Plumbin WORK Alteration Electric <br /> 'S- h5 �Y G���� �� // TYPE Oemolilion Fj Sign 9 TYPE � New � Gas <br /> Sprinkler RepaidMaint. . l.� Other <br /> CONTRACT PRICE OF WORK I CITY OF EVERETf iACAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION '^/ j �/� <br /> /V -2 �C/ 5.�vrlL� T4i�Ji�� Jyi-y—G. <br /> \ 1 /�.�:� ��Gl /�C- 'sL�'� U[.2 I> �J U. � r�-) i <br /> PLUMSING ' MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM IJO. TYPE OF FIXTURE OR ITEM <br /> i 3 WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> '3 BATHi"UB �. FORCED AIR SYSTEMS <br /> '1 LHVATORY(WASH BASIN) -Ca- HEAT PUMP <br /> � SHOWER -E3- UNITHEATERS <br /> � KITCHEN SINK& OISPO:AL T CLOTHES DRYER <br /> � DISHWASHER T RANG[ HOOD <br /> -F�- LAUNDRY TRAY � WATER hEP.TER <br /> ( CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> -r�- D�-fINKING FOUNTAIN L GAS FIREPLACE � <br /> I ,��� FLOOR DRAIN -(�' GAS RANGE i <br /> BACKFLOW PREVENTER � GAS PIPING I <br /> �� SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> _ OTHER _� OTHER <br /> — � <br /> I — — � <br /> I I - <br /> � I HEREBY CFRITIFY THAT I HAVE READ AND EXAMWED THIS APPLICATION AND KNOW THE SAME TO BE?RUE AND CORRECT. ALL <br /> I PROVISIONS OF LANJS AND GRIUINACES GOVERNING TNIS TYPE OF WORK IYILL BE COMPLIED NJITH WHcTHER SPcCIFIED HEREIN OR <br /> � NOT. THE GRANTING OF i�PERAIIT DOES NOT PRESUh1E i O GNE AUTHORI�y TO VIQLATE OR CANCEL TH�PROVISIGM OF ANY OTHER ' <br /> STATE OR LOCH�LAW REGULATING CONSTRUCTION OR THE PERFORM1IANCE OF CONS'RUCTIO'L THAT I A�d AUTHORIZED BY THE �I <br /> OW�dER GF THIS PROPERTY TO PERFOFAi THE'NORK FOR WHICH APPLICATION IS AtACE AND I COMPLY WITH THE STAT'e I <br /> CO'JTRACTORS LAIN 18.27 RCYV A D 296?00 NAC. ��, <br /> � � � I <br /> -,c-"��� � �2 � � I <br /> iSignature of Owr.er ontra or/Authorized Agent Date � a I <br /> _ DEBIT & CREDIT CARDS ARE NOT ACCEPTED � <br />