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PERMIT APPLICATIt�N �'`�"'s�` `'`',.�I <br /> CITY OF EVERETT PERMIT SERVICF_S ��� �I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 � /�OA�.. ��� �y <br /> S-d b�� Qi43 r C 22 cJ.TL_ � <br /> SITE ADDRESS PARCEL TAX I.D.# RMIT# <br /> q�lo � 6� �a��� � , ��rx� ��GS-G(J5� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. � ` <br /> OWNER ADDRESS ��� / PHONE I <br /> �vKs �e Bui�D�M.J i,�/C Po . BoX /5'79 . .Tn/on�owv.s<1. WA� ��fzj sS - 9aou <br /> TENANTNAME I CONTACTf=ORPER IT PHONE <br /> C'RA�(y /v(oR�iSc�✓ �y�zS� 3�y—/000 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> C'M'T ..l�A+.+c q s �'0 v E <br /> P�4z�1 353- 9oop C�Ir��t�o8S�3 <br /> PROPOSED USE OF BUILDING Building Mechanical Addition HEAT SOURCE <br /> PERMIT � CombinatiOn � Plumbing WORK � Alteration � Electric � <br /> /�� SF� TYPE Demolilion � Sign TYPE New Gas <br /> Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK #//� /, CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> b i� <br /> WORK DESCRIPTION <br /> �t! E-c-�1 S F� I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR I fEM <br /> � WATER CLOSET(TOILET) – A/C–A/HANDLING UNITS <br /> � BATHTUB *I+�^�Q 1 FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUh9P <br /> S�-IOWER UNIT HEATERS <br /> �_ KITCHEN SINK& DISPOSAL �_ CLOTHES DRYER <br /> _L_ DISHWASHER J_ RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> I CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> = DRINKING FOUNTAIN _L G.AS FIREP�ACE <br /> – FLOOR DRAIN ' GAS ftANGE <br /> BACKFLOW PREVENTER l GAS PIPING <br /> = SINK(SERVICE/BAR/MOPlETC.) � EXHAUST FAN <br /> OTHcR OTHER <br /> I I HEREBY CERITIFY THAT I HAVG READ AND EXAMINED THIS APPLiCATION AND KNOW THc SAME TO 8E TRUe AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK I�VILL BE COMPLIED WI7H WHETHER SPECI"rIED HEREIN OR <br /> NOT. THE GRANTING OF A PERAt1T DOES NOT PRESUPdE TO GIVE AU7HORITY TO VIOLATE OR CANCEL THE PROVISION OP ANY OTHER � <br /> STATE OR LOCAL WW REGUWTING CONSTRUCTION OR THE PERFORPAANCE OF CONSTRUCTION. THAT I AM AUTHORIZED EY THE <br /> OWNER OF THIS PROPERTY TO PERFORM1i THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CO TRACTORS 18.27 RCW AND 296.200 WAC. — <br /> � � <br /> Signature f OwnedConiractor/Aulhorized Agent D o� �/ <br /> DEBIT & CREDIT CARDS ARE hOT ACCEPTED Z <br />