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� PERMIT APPLICA i ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT� <br /> �1 /�/� S� o3d5� - Q3 <br /> LEGAL LOTNO. I BLOCK TRACT <br /> DESC. � ,�j$i(���k�r . <br /> OWNER AODRESS ZIP PHONE <br /> �onlCo_ � �Ja�P � l�rK�r � /�231 I�(fh b� SE i�.1o$ y�S)337-1.Za3 <br /> TENANTNAME � CONTACTFORPERMIT PHONE <br /> � nrC � �oc./SC�r� `l.?S� 3S`(-i��(O <br /> CONTRACTOR ADDRESS 21P CONTR.LICENSE# <br /> (J�:✓r`s 12s�,�1/a�i on i l/o ��07��� YSiaa f �Al/��S I I osONS <br /> PHONE <br /> °las�asq �161 y <br /> PROPOSED USE OF BUILDING Building �Mechanical Addition HEAT SOl1RCE <br /> PERtAIT R Combinalion Plumbing WORK � Alteralion � Electric <br /> TYPE g Demolition Sign IYPE New Gas <br /> �P5��n.�1�� Sprinklef Repair/Maint. Olher <br /> CONTRACT PRICE OF WORK tf7 0� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> �v� <br /> WORK DESCRIPTION , <br /> /n5Y�0.'[�'4'iol� 01� c`c.5 � t�l �� <br /> J <br /> I <br /> PLUMBING MECHANICAL <br /> NO. 'IYPE 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 /> KITCHEN SINK 8 DISPOSAL I� CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY I _LC . WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL I _j� FIREPLACE INSERT <br /> DRINKING FOUNTAIN �A GAS FIREPLACE <br /> FLOOR DRAIN � � GAS RANGE <br /> li _ BACKFLOW PREVENTER �,� GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER 1 � OTHER rrzn� `� <br /> I HERE81'CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEReIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NO i PRFSUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFO4AIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATe <br /> CONT ORS W 1827 W AN 96.200 WAC. <br /> ��.����/� S-�3 -03 <br /> Signature of OwnedContractor/Authcnzed Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />