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_ ---- — - — q,,,�G us�q �valT�. <br /> PERMIT APPLICATION n�tn��z ��s�c <br /> CITY OF EVERETT PERMIT SERVICES (3�.s �c� 2Z�`I <br /> 3200 CEDAR STREET, EVERETT, WA 98?01 <br /> 425-257-f;J10 — FAX 425-257-8857 <br /> SiTE AUDRESS PARCEL TAX I.D. # PERMIT� � <br /> 9 32L �b� DR� v� � . �'U�IUS �/0 <br /> LEGAL� LOT NO. BLOCK TRACT ' <br /> �Es� r Z�f <br /> '� OWNER ADDRESS ZIP PHONE <br /> Cms 1-�m.ntf3u�Wevi., i.Jc , Po�oX/57q� Sti�oN�M�.ry,u/A �8291 ��-/2T) 353-J�ud� <br /> TEHANT NAIdE I CONTACT FOR PERMIT PHONE <br /> � C2alct /✓r�a�rra.�.1 (�{z.r) 3�9-lvoo ' I <br /> CONTRACTOR AODRESS ZIP CONTR. LICENSE x � <br /> �wt.r S',4.Kc RS A8a✓� <br /> P NE Cw�s'snl ��ogsr�3 �, <br /> ' ��{2>� 3S3 -�j000 <br /> ' PROPOSED USE OF BUILDING (� Building D MeCh3nical Atltlilion HEAT SOURCE <br /> I PERAIIT r C�mbination u PlUmbi�g WORK � Al��talion � Electnc <br /> �� � � ,Q '!YPE D Demoliticn U Sign TYPE New Gas <br /> �� U S rinkle� R= airlMaint. I Other <br /> �� CONTRACT PRICE OP WORK �// O,OOO CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 � <br /> (D <br /> , WORK DESCRIPTION <br /> I Cth✓S n��-� N�"J 'S�/L <br /> I PLUMBIIJG MECHANICAL <br /> NO. I NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 � WATER CLOSET (TO�ILE� T) A/C—A/HANDLING UNITS <br /> � BATHTUB wI la'"^� i�FY�f I FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) HEAT�UMP <br /> SHOWER UNIT HEATERS <br /> i _/_ KITCHEN SINK& DISPOSAL � CLOTHES DRYER <br /> � DISH'J✓rSH[R J_ RANGE HOOD <br /> , LAUNDRY TRAY �_ WATER `1EATER <br /> �� I CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL � FIREPLACE IN.�.FRT <br /> ' _ DRINKING FOUNTAIN y GAS FIREPLA:;:_ <br /> _ FLOOR DRAIN GAS RPNGE <br /> BHCKFLOW PREVENTER � GAS PIPING <br /> ' ^ SINK (SERVICF/BAR/MOP/ETC.) � EXHAUST FAN <br /> �� OTHER OTHER <br /> i <br /> i HERE9Y CERITIFY THAT I HAVE READ AND EXAtiiINED THIS APPLICATION AND KNOW THE SFME TO BE TRUE AND CORRECT ALL <br />� � PROVISIONS OF�WS AND ORIDINACES GOVERNING THIS TYPG OF WORK WILL 9E COMP�IED WITH VVHETHER SPcCIFIED 'nEnEli l J�, <br /> VOT. THE GRAI�TING OF A PERMIT GOES NOT PRESUM11E TO G�VE AUTHORITY TO VIOLA7c OR CANCEL THE PRO:'ISIOh GF r�IJV G'--�� <br /> ' S i ATE OR LOCAL LAW RGGULATING CONSTRUCTION OR THE PERFORI.1HNCE OF CONSTRUCTION. THAT I AM AUTHO�4IZF.D dY'`-c <br /> �. OVJN�R THIS PROPE TY TO PERFOR61 THE WORK FOR WHICH APPLICATION IS�.tADE AND I COMPLY WITH THE STATF. <br /> � CONT GRS LAW 1 27 RCW AND 296200 WAC. <br /> s s�o 5/ <br /> Signawre of C. nerlContractoriAuthorized Agent Date <br /> _ DEBIT & CREDIT CARDS ARE NOT ACCEPTED __ I�v <br /> —f <br />