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PERMIT /�PPLICATION �``�`�s"� �� <br /> �.a� �l z <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �o�� J s 3a �A <br /> 425-257-8810- FAX 425-257-8857 <br /> _ Bas� c Zzy3 <br /> SITE ADDRESS PARCEL TAX I.D. # PER iT n <br /> 9�11� 16?� ✓� � �✓�M.cT,- G�j-�;G � <br /> LEGAL LOTNO. 8 OCK TRACT <br /> oesc. c�2 <br /> OWNER AODRESS ZIP PHONE � <br /> C''h-T l�wuG J�u�c.s�rN1 � /�II[ . /dQox �579 , I,�.,��,,�s�, c��I �b'2p/ �yZs�3�3-faod <br /> I TENANT NAME CONTACT FOR PERMIT PHONE <br /> � C�R� 4 /�'foRttrso.J ��(z�) 359-/oou <br /> CONTRACTOR ADDRESS ZIp CONTR. LICENSE# <br /> Cw�r ,5,�„K� q s A�o ��' <br /> PHONE C�v1TTn���085M 3 <br /> _�(zs� 3 s3- qo 0 0 <br /> PROPOSED USE OF BUILDING Building f�1 Mechanical A�dition HEATSOURCE <br /> PERMIT Combinalion fI-�-( Plumbing WGRK Alleration Electric <br /> � �,., r /- TYPE Demolition U Sign TYPE � New � Gas <br /> e(�ll ,S !-2 Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK I �Q � CITY OF EVERETT LOCAL SALES TAX CODE�S 3705 <br /> ___ K �NQu.p�a , /aoe <br /> WORK DESCRIF I(Ghl Lo� G ST <br /> PLL'MBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �_ WATER CLUSET(TOILET) A/C–A/HANDLING UNITS <br /> � BATHTGd J_ FORCED AIR SYSTEMS <br /> � 1.,4VATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> 1 K�TCHEN SINK& DISPOSAL J_ CLOTHES DRYER <br /> I DISHWASHER �_ RANGE HOOD I <br /> LAUNDRY TRAY J_ WATER HEATER <br /> �_ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> = URINAL FIREPLACE INSERT <br /> = DRINKING FOUNTAIN J_ GAS FIREPLACE <br /> - FLOOR DRAIN GAS RANGE <br /> �ACKFLOW PREVENTEk -� GAS PIPING <br /> � SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> II HEREBY CERITIFY THAT I HAVE READ AND E.YAAIINE�THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL ��� <br /> PROVISIONS OF LAWS APlU ORIDiNACES GOVEFNING THIS TYPE OF WORK WILL BE COh7PLIED WITH WHETHER SPECIFIED HEREIN OR <br /> , NOT. THE GRANTING OF ;PERP.11T�OES NOT PRESU�dE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER I <br /> S7ATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PEP.FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZFD BY THE <br /> OWNER OF THIS PROPERTY TU PERFORM THE WORK FOR WHICH APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br /> CO RACTORS �W 78.27 RCW AND 296.200 6VAC. I <br /> / <br /> --� I <br /> Signature f OwnedConlractodAuthorized Agent te <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED I�,/� <br /> -T <br />