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` �G us;�q c,�7va01. <br /> ,� <br /> PERMIT APPLICl�TION n�tn��c is38c <br /> ��ITY OF EVERETT PERMIT SERVICES (3�.s ic# ZZ�3 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D. # PER�:t1T� <br /> Y3 �7 /G� DQrv� (,1.� . �(xioS' �=��� <br /> - ��-� �BO. � BLOCK TRACT <br /> �ESC <br /> OWNER ADDRESS ZIP PHONE <br /> Cms l.la,�r;l�u�w�, i�e , POB�X/57y� s�o,yu•-i�ty�u/A �I8291 ��-IzT) 3S3-J�ua� <br /> TENANT NAME CONTACT FOR PERMI7 PHONE <br /> C2A�Ict �,K�R,�rta.J ��{a.� 3��1-(000 � <br /> � CONTRACTOR ADDRESS ZIP CONTR. LICENSE# <br /> �n�tr 1�4.w.c as p.Bo �e <br /> ar Ne Cna..rsn/ ��xogs.�3 <br /> zJ) 3S3 -�oo0 , <br /> PROPOSED USE OF BUILDING Building Me:hanical Addition HEAT SOURCE <br /> I PERMIT 1Rj Combinalion R Plumbing WORK � Alteration � Elecvic <br /> � (` c /� NPE D Demolition D Sign NPE New Gas <br /> `� � �� U Sprinkler RepairrP.lainc Omer <br /> � CONTRA,r,7 pRICE OF WORK `�Y// �/0� CITY OF EVERETT�OCAL SALES TAX CODE IS 3105 , <br /> LO <br /> � WORK DESCRIPI'ION � <br /> Gfl,✓S�u.e-T N d"�'�'1 S�/Z <br /> PLUMBING MECHANICAL <br /> NO. I NPE OF FIXTURE OR ITE�d NO. NPE OF FIXTURE OR ITEM , <br /> 3 WATER CLOSET�ST�O.IL�Ej�)��� A1C—NHANDLING UNITS <br /> � � BATHTUB wI l�"^+( �W�J I FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) HEAT PUP�iP <br /> SHOWER UNII'HEATERS <br /> � KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER ' <br /> __L DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY �_ WATER F;EATER <br /> I CLOTHES WASHER METAL FIREPiACE/STOVE <br /> ' URINAL � FIREPLACE INSERT <br /> DRINKING FOUNTAIN = GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW f�REVENTER GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> OTH�R OTHER <br /> � ��EREBY CERITIFY THAT I HAVE READ AND EtiAA11NED TNIS APPLICATION AND KNOW THE SAMF TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND OR!DINACES GOVERNING Tr!�S TYPE OF WORK WILL BE COMPUED WITH WHETH�k SPECIFIED HEnEIN OR <br /> 'vOT. i HE GRANTWG OF A PER611T DOES NOT PRESU�dc TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW R GULATING CONSTRUCTION GP.TF1E PERFORFdANCE OF CONSTRUCTION. THAT I A��1 AUTHORIZED BV T�,E <br /> ��'.VNER THIS PROPE Tl'TG PEf2FORM THE WORK FOR WHICH APP�ICATION IS MADE AN�I COM1t?�Y:"lITH THE STATc <br /> :�NT ORS LAVJ 1 27 RCW AND 296.200 WAC. <br /> � • ��s�o�, <br /> S�qnawre of 0� nedContrectodAuthorized Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED I/� ' <br />