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f�ERIVIiT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-9810- FP,)i 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> y� s l /z ��t c.� z ��>�, , 3 cjz-s s�� G;�/�'i% <br /> LEGAL lOT N0. BLOCK TRACT <br /> oesc. / �/ �o�'�Li G ��cc �t G�i-��ti S <br /> OWNER ADDRESSQ�f G�t�� =1P PHONE y�f— <br /> �=aG�ciS o`i'I Cbti�i�vc�%�5 1 v�4 LYhh wmed w� ypo3� 772- 20,$- <br /> TENANTNAME � I CONTACTFORPERMIT PHONE <br /> -� // yz't' <br /> �'��/ l�,r�.c%rs e si �7 z- z os� <br /> ��������$ CuH�i�4GTi'N) ADDRESS Bp� 6�' �C/ ZIP CONTR.LICENSE# <br /> PHONE �HC• [�,y/� L.�+fim�J (✓N. ���� <br /> �/zt" 77z- 2oS� I��'/V/)���'OOSG <br /> PROPOSED USE OF BUIL�ING Building Mechanical Add�tion HEAT SOURCE <br /> s,'HJ�{ {�uM%�7 PERMIT �Qq Combinatian Plumbing WORK Alteratian Q Electric <br /> TYPE �.�j Demolilion � Sign TYPE New 6 Gas <br /> /�b�.t U Sp�inkle� RepaidMaint. Oth�r <br /> CONTRACT PRICE OF WORK CITY OF EVERETI�LOI:AL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION n ' <br /> 'S�� A,S' �Y f'"4 M i'/`r /-`�.f /� �h�'� . <br /> '� l�5Z �,�225� <br />' PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR I'fEM NO. TYPE OF F�CTURE OR ITEM <br /> WA7ER CLOSET(TOILET) � A/C-A/HANDLING UNITS <br /> t BATHTUB �� FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) -e" FIEAT PUMP <br /> �_ SHOWER -B' UNITHENTERS <br /> �_ KITCHEN SINK& DISPOSAL � CLOTH[S 17RYER <br /> � DISHWASHER � RANGE HOOD <br /> -E3- LAUNDRY TRAY � WATER HEATER <br /> � CLUTFIES WASHER � METAL FIREPLACE/STOVE <br /> � URINAL -6' FIREPLACE INSERT <br /> -6� DP.INKING FOUNTAIN � GAS FIREPLACE <br /> jr FLOOR DRAIN GAS RANGE <br /> � BACKFLOW PREVENTER , � Y GAS PIPING <br /> -�9 SINK(SERVICE/BARlMOP/ETC.) � EXHAUST FAN <br /> OTHER QTHER <br /> I HEREBY CERI7IFY THAT I HAVE READ AND E?'AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACcS GOVERNING THIS TYPE OP WORK WILL BE COMPLIED'vVITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRGSUME TO GIVE AUTHORITY TO VIOLATE CR CANCEI THE PR!�VISION QF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONS7RUCTION. THAT I AM AUTHORI2ED 81'THE II <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COM1IPLY WITH TF�STA7E <br /> CONTRACTORS LAW 18.27 RCW AND 296.200'JVAC. <br /> �T�i D d���� ii r a � ' <br /> Signature of 0 edContraclor/Authorized Agent Date <br /> i DEBIT & CREDIT CARDS ARE NOT ACCEPTED �Z <br />