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P�RMIT APP'LICATION m��z ��s 8� <br /> CITY OF EVERETT PERMIT SERVICES (�'�.s 1�� z243 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-88�� - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D. # <br /> /]q.L Q PERPAIT„ <br /> �17 U Jlor" D2� ✓E t,J . u OS- c� <br /> � LEGi,L LOT N0. BLOCK TRACT <br /> ots� r z 3 <br /> OVlNER AD�RESS <br /> ZIP PHONE <br /> �mT �.(awtE(Sutc-Ja^rt� /�C , POB�,r/57 <br /> 9, S�o,yo��ly u/A �BZq� ��zs) 3s3-y'uo�, <br /> TENANT NAME CONTACT FOR PERMIi — <br /> PHONE <br /> C2A�rct /�a,tr.ro.J (c�a,� 3'�'�1 l�oo <br /> � CONTRACTOR ADDRESS ZIP CONTR. UCENSE# <br /> �M.T S�-�c As A.Bo�a <br /> P NE <br /> �c(2�) 3S3 -�000 Cn�s'inl *�o8s�3 <br /> : PP.OPOSED USE OF BUILDING I f� BUilding Mechanical Atldition HEAT SOURCE <br /> PERMIT �I�-( Combination Plumbing WORK � qlteration Elecirc <br /> ' � F' � TYPE u Demolilion � Sign TYPE Ne�v � Gas <br /> U Sprinkler RepaidMaint. Other <br /> CONTRACT PRICE OF WORK SC// O ODO CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br /> (D <br /> WORI( DESCRIPTION <br /> C�s r-�u*-►- �v�-�..� -�'�2 <br /> PLUMBING MECHANICAL <br /> ' NO. I TYpE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 WATER CLOSET(TOILEJ') A/C–A/HANDLING UNITS <br /> � � BATHTUE w/t,d�.�( (�M1qb1 1 FORCED AIR SYSiEMS <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> ' � DISHINASHER <br /> ��� IAUNDRY TRAY J_ RANGE HOOD <br /> I CLOTHESVVASHER � WATER HEATER <br /> URINAL � _ METAL FIREPLACE/STOVE <br /> DRINKING FOUNTAIN FIREPLACE INSERT <br /> _I FLOOR DRAIN � GAS FIREPLACE <br /> BACKFLOW PREVENTER � GAS RANGE <br /> _�� GAS PIPING <br />; _ SINK�SERVICE'BAR/MOPiETC.) �_ EXHAUST FAN <br /> � OTHER _ OTHER <br /> —I <br /> I — <br /> ��ERE9Y CERITIFY THAT I HAVE READ AND EXAMINED 1 HIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. i.LL <br /> ?RC;�ISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED Mc"REiN OR <br /> '<OT THE GRANTING OF A PERMIT DOES NOT PRESUMe TO GIVE AUTHOR17Y TO VIOLATE OR CANCEL THE PROVISION OF ANY O7i,=_R <br /> S i ATc OR LOCAL LA4V R GULATING CONS7RIJCTION OR TH't PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZFD i37 T <br /> .:'7NER i HIS PROPE TY TO PERFORM TH[WORK FOR WHICH APPLiCATION IS A1ADE AND I COMPLY WITH THE STA i E <br /> �.'ONT ORS LAW 1 27 RCVV AND 296.200 WAC. <br /> � � s s�o 5/ <br /> Si;nature of 0. neriCnntractodAuthorized Agent Date <br /> _ __ ___ DEBIT & CREDIT CARDS ARE NOT ACCEPTED �I Z, <br />�_ __ <br />