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PERMIT APPLI�CATION �`'`� "s%� �°�Dl <br /> CITY OF EVERETT F'ERMIT SERVICES L�r �� <br /> 3200 CEDAR STREFT, EVERETT, WA 98201 MO�� /S 3I, 13 � <br /> 425-257-8810 - F�X 425-257-8857 <br /> l3�s�c zz�'3 � <br /> SITE ADDRESS PARCEL TAX I.D.# P'RMIT a <br /> 9�fo 1 6� a�v� t,J �eti�sr S�D.�—�iG9 <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. �� <br /> OWNER ADDRESS ZIP PHp NE <br /> l�(u).3S'�-`joa'' <br /> G.�.�. ��c�..c flu r�D�riS � /la�C. P4 Bo�/5 79 , Snlo�la,vlrtsl K�� �'z9/ <br /> TENANT NAME CONTACT FOR PE�—�� PHONE <br /> L/tAf ( /r(n�a�sa ,� (yzs� 3sy-,o�o <br /> CONTRACTOR A�DRESS ZIP CONTR.LICENSE# <br /> c•�� Sq.µc �Fs ►413ov� <br /> �� NE � CMJZ"n1-i�-�0 3 <br /> tn 3�3- o0 o J'SM <br /> PROPOSE�USE OF BUILDING 6uilding D Mechanical Addition HEAT SOURCE <br /> PERMIT � Combination u Plumbing WORK � Alteration � E-lectric <br /> �,.1 iYPE Demolition U Sign TYPE New Gas <br /> Nt�' S r� Sprinkler RepairiMainl. Olher <br /> CONI'RACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 � <br /> WORF:OESCRIPTION <br /> N � sr�2 <br /> PLUMBING MECHANICAL <br /> N0. TYpE OF PIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET(TOILET) A/C–A/HANDLING UNITS <br /> 2 BATHTUB _L FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) HEAT PUR4P <br /> � SHOWER UNITHEATERS <br /> � KITCHEN SINK&DISPOSAL 1 CLOTHES DRYER <br /> � DISHWASHER _(_ RANGE HOOD <br /> LAUNDRY TRAY _L WATER HEATER I <br /> 1 CLGTHES WASHER METAL FIREPLACE/STOVE <br /> – URINAL FIREPLACE INSERT <br /> = DRINKING FOUNTAIN _(_ GAS FIREPLACE <br /> _ FLOOR DRAIN i_ GAS RANGE <br /> _ BACKFLOW PREVENTER "d GAS PIPING <br /> = SINK(SERVI�E/BAR/MOP/ETC.) � EXHP.UST FAN <br /> = OTHER = OTHER i <br /> I HEREBY CERITIFY THAT I HAVE RE.4D AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORR[CT. ALl <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE CO�dPLIED WITH WHETHER SPECIFIED HcR61N OR <br /> NOT. THE GRAN fING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO FERFORM THE WORK rOR WHICH APPLICATION IS MADE AND I COMPLY VJITi. �HE STATE <br /> CONTRACTORS \N 18.27 RCW AND 296.200 bVAC. <br /> .S— � <br /> Signature f OwnedContrector/Authorizcd Agent ate <br /> DEBIT & CR[DIT CARDS ARE NOT ACCEPTED '� � � <br /> �—� <br />