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� PERMIT APPLICATIOlV '�`^�Ks�a, �d�,J 'i <br /> CITY OF EVERETT PERMIT SERWICES 1„or �3 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857 M o D�t. l�3g F' � <br /> /3,��t�c 71 y3 <br /> I SITE ADDRESS PARCEL TAX I.D. # PERMIT� <br /> )� <br /> q�s /6%?`� �a i�E cJ. £,,,, ,, GS'z%`O <br /> LEGA�LOTNO. BLOCK TRACT <br /> �ESC. <br /> OWNER ADDRESS ?!P PHONE <br /> ►�o, B ��Z�q� <br /> C�-� l-�ow,EBur�D cn�,:Wc, ux /S 79 ,_f..��,�l�n,��.rH WA ��L�"'1353- `!'000 <br /> TENANT NAME I CONI'ACT FO PERMIT �— PHONE <br /> C/Z � �(_ /l��12rs� (�{L�} 3sg - /voo <br /> CONTRACTOR ADDRESS ZIP � CONTR.LICENSE# <br /> G'M.T <br /> PHONE .�A-^'lf /4S /Q�CIVt C�'�LT.rII.I'y['�FOIfS/y� <br /> �yz,s� 35?' 9oao -3 <br /> PROPOSED USE OF BUILDING Building Mechanical �;ddition HEAT SOURCE <br /> PERMIT R CPmbinalion � Plumbing WORK � AltPrafio�� I � Elechic <br /> ./`� J' �� 1YPE D 6emolilion Sign 1YPE New Gas <br /> �� U S rinkler Re air/Maint. I Other <br /> CONTRACT PRICE OF WORK ,�//a /� CITY OF EVERETT LOCAI.SALES TAX CODE IS 91G5 <br /> m f <br /> WORK DESCRIPTION <br /> � E�J .S/—IL <br /> PLUI'dBING � tJIECHANICAL <br /> N0. TlPE OF FIXTURE OR ITEM NO, TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET(TOILET) ' /�/C-A/HANDLIN(3 LI,lITS <br /> L BATHTUB � FORCED AIR SYS'�EMS <br /> � LAVATORY(WASH BASIN) H[AT PUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK& DISPOSAL � CLOTHES DRYER <br /> J_ DISHWASHER � RANGE HOOD <br /> - LAUNDRY TRAY � WATER HEATER <br /> � I CLOTHES WASHER _ METAL FIREPLACE/STCVE I <br /> _ URINAL FIREPLACE INSERT <br /> __ DRINKING FOUNTAIN _1 GAS FIREPLACE � <br /> _ FLOOR DRAIN GFlS RANGE <br /> _ BACKFLOW PREVENTER G.�:.S PIPING <br /> _ SINK(SERVICEIBAR/MGP/ETC) �I EfiHAU;3T rqN <br /> OTHER__ � OTHER <br /> — --- — I i --- � <br /> I ;IiE12EBY CERITIr'Y THAT I HAVE READ P.�JD EXAWINED THIS APPLICATION AND KUpyV TI1E SAME TG BE TRUE AND CORRECT. ALL I <br /> I PROVISIONS UF LAN:S AN�ORIDINACES GOVERNING THIS TVPE OF 4VORK WILL 6[i.OMPLIED WITH l'JHETFER SP�GPIED HEREIN OR �� <br /> NOT. THE GRAP�TING OF A PERMIT DOES NCT PRESUME TO GIVE AUTHORITY TO ViC'ATE OR CAPICF.L THE PRO\'ISION CF ANY OTHER I <br /> S7ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CO'J3TRUCTION. THAT I AM AUTHORI2ED BY THE � <br /> OWNER OF THIS PFjOPERTI'TO PERFORM THE WORK FOR WHICH APPLICATION IS MAG�AND I CON�PLY WITH THE STATE <br /> CON ACTORS LAN'18.27 RCW AND 296200 WAC. <br /> '✓ � �� 0 � <br /> Sig ature t OwnedConiractor/Authorized Agent D te I <br /> DEBIT 8 CREDiT CARDS ARE NOT ACCEPTEL �/ I <br /> — — ( �, <br />