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_ — ; — [�u4 us�q vaAT <br /> PE�2MIT APPLICATIOi� mn��z is.�A <br /> CITY OF EVERETT PERMIT SERVICFS g�., �c� Zz�3 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX�.�.# PERktiT tt <br /> � 323 Gr" Dk��E � . �' �)y�.� C%2 <br /> LcG:,L LOT NO. BLOC�C TRACT ' <br /> oES� 37 <br /> � OWNER ADDRESS ZIP PHONE <br /> C.�+s �.(u,.n�ISu�c��, iNc , pO�oX/57y� S�o,yaM�ty.ulA Y�z91 ��-IZs) 3�3-/�u�o <br /> TENANT N�1ME CONTACT fOR PERMIT PHONE <br /> I C2arct /�oR�rso.J (�{Z.T� 3��!-/000 <br /> CONTRACTOR ADDRESS ZIP CONTR. LICENSE# <br /> Cwtr S'�4-tic as F�Bo�� <br /> P NE Cw�l'inl *�ogsr�� <br /> �c(2j) 3S3 -�j000 <br /> PROPOSED USE O�BUILDING I� Building ( Mechanical Adcition HEAT SOURCE �� <br /> I PER�dIT �� Combination � Plumbing WORK � Atlerahon � Electnc <br /> � c' ./� TYPE �,7 Demolition Sign 1'YPE New Gas � <br /> . � �� U Sprinkler RepairR.fainl. Other <br /> � <br /> CONTRACT PRICE OF WORK �// O/p� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �� <br /> (D <br /> WORK DESCRIPTION <br /> G�sr+�-r Nd'^� SFlL <br /> � PLUMBIIJG MECHANICAL <br /> ' NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 WATERCLOSETS'TO•ILE�) rVC-A/HANDLINGUNITS <br /> � BATHTUB wI l�^^� �01 I FORCED AIR SYSTEMS <br /> t�( LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> _L KI'i CHEN SINK& DISPOSAL J_ CLOTHES DRYER <br /> _( DISHV��ASHER 1_ RANGE HOOD <br /> LAUNDRY TRAY �_ WATER HEATER <br /> I CLOTHES WASHER I _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN � GAS FIREPLACE <br /> _ FLOOR CRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK (SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> I _ OTHER _ OTHER <br /> I — I = <br /> � i nEREBY CERITIFY THAT I HAVE READ AND EXAh11NED THIS APPLICATION ANO KNOW ThE SAME TO BE TRUE AND CORRECT. ALL <br /> � aROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL 9E COMPLIED WITH WHETHER SPECIFIED HEREIPi GR <br /> NOT THE GRANTWG OF A PERMiT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTnER <br /> � S i FTC OR LOCAL_AW R GL'LATING CONSTP,UCTION OR THE PERFORMANCE OF CONjTRUCTION. THAT I AI',7 AUTHOP.I?ED BY TME <br /> � OV'JNER THIS PROPE TV TO PERFOR61 TF;E WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY V�97:� i NE STH i E <br /> ' CONT ORS LAIN 1 _7 RC�V AND 29"0.200 N'AC. <br /> ' .S' s�o� <br /> �, Signawre of 0� nedContractouAuthorized Agent Dale <br /> _ __ DEBIT � CREDIT CARDS ARE NOT ACCEPTED �/., <br /> --�--- <br />