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P�RMlT APPLICATION P"°'' "3`� F <br /> CITY OF EVERETT PERMII' SI=RVICES <br /> 3200 CEDAR STREET, EVERETT, WP. 98201 <br /> 425-257-8810 — F.4X 425-257-8857 <br /> ��3 <br /> SITE ADDRESS PARCEL TAX I.D. # PER�,�iT x <br /> � � �� ��I�IVC � CX� C��y'OCc�00� 0 _j,SUO �(�� �"�" � <br /> �_cG:.0 LOT NO. BLOCK TRACT <br /> �esc �cG us,—N L•`oeOS <br /> O'vVNER DDRE55 21P PHON <br /> I (yz;�:s. -��ou o <br /> �,��_ �/�w,���� , �� �ns ,s,� � . p� a�X�s�y . .J�I/Q�owl/Jf�� cJA ���� � <br /> TENANT Nl�ME I CONTA(:T FOR PERMIT PHONE <br /> I <br /> CONTRACTOR ADDRESS ZIP CGNTR. LICENSE# <br /> C .�i> �0 /s o�C /.S`�`! � .5����`Fu.� r sr.i, u1 ry ;��'z�/ c.��rr�!-,f�c o 85'm 3 <br /> PNONE �XV ��/�t��L:nS <br /> (c{L�') 3.7 3 • 9oou <br /> PROPOSEO USE OF BUILDING BUild'If1g � Mechanical Adtlition HEAT SOURCE <br /> PERMIT � Combination Plumbing WORK R ni�eration � =_iecurc <br /> ���Z,,,` ��a.Sc �vn)Si7'LUt'i'Z 7ypE Demolition Sign TYPE � New Gas <br /> �S r-�`, Sprinkler U RepainMaint. Other <br /> CONTRACT PRICE OF WORI: � ���0O CITY OF EVERETI'LOCAL SALES TAX COOE IS 7105 <br /> WORK DESCRIPTION <br /> _SF� �A S � � zz � � F� <br /> P�UMBING h1cCHANICA:.. <br /> N0. I TYPE OF FIXTURE OR ITEM NO. TYFE OF FIXTURE OR I�fEM <br /> �—� Wr.TER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> 'L BA.THTUB f FORCED AIR SYSTEMS <br /> 3 LF�VATORY(WASH BASIN) HEAT FJMP <br /> - SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> � � GISHWASHER � RANGE HO00 <br /> ^ � LFUNDRY TRA1' � 'NATER HEATER <br /> � C�OTNES WASHER _ METAL FIREPLACE/STOVE <br /> =I URINAL FIREFLACE INSERT <br /> — ' DRINKING FOUNTAIN ! GAS FIREPLACE <br /> � FLOOR DRA!N / GAS RANGE <br /> ! 9ACKFLOW PREVENTER � GAS PIPING <br /> SINK (SERVICEIBARl�dOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I <br /> . nERE9Y CERITIFY THAT I HAVE READ AND EXAMINED'fH1S APPLICATION AND KNOW THE$AME TO BE TRUE AND CORRECT. ALL <br /> .'-ROvi5i0N5 OF LA4VS AND ORIDINACES GOVERNING TI'IS TYPE OF WORK WILL BE COMPUED WITH WMETHER SPECIFIED ri'cREl�v CR <br /> >.0 i '.r.'c GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OT�c.R <br /> jTHTE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I APd AUTHORIZED 9v TME <br /> G'.:'NcR OF TEIS PROP R7Y TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I C �MPLY WITH THE STATE <br /> �ONT ORS LAW t 27 RCSN AND 296200 WAC. <br /> � � L� t� /L�3� /�3 <br /> S�cn ure of wned ontractor/AWhorized Agent Date ��� <br /> DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br />