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PERfVIIT APPLICATION �� <br /> CITY �F EVERETT PERMIT SERVICES <br /> 3100 CEUAR STREET, EVERETT, WA 9&201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# I <br /> _�10 i�??p pR�Ut c� �'vr Cn4�3 -� <br /> LP.GA� LOTNO. BLOCK TRACT ' I1 <br /> DE'Sr, b�U ::Y� (�Od�f <br /> OV6'NER ADDRESS ZIP PHONE <br /> C.�.z /�,..�cQu�cvr+rt5 � i�C �o�X /5`l9 .S�a��s,cl, u�i� �b'Z9� �c/z�—�?S 9—/0�0 <br /> TENF�NT PlAME CONTACT FOR P RMIT PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> ('I�t.�" <br /> PHONE �N9.17/1I7CyK�f�-S•Y�3 <br /> �{L� 3 5—`1 -l o ap �d Q ax /5�y� �..-)a,t/�wt r-�� l.�� y�Z-H� <br /> PROPOSED USE OF BUILDING Building fl Mechanical Adtlition HEAT SOURCE <br /> PERMIT Combination K Plumbing WORK RI--( Alteration Q Electnc <br /> �v G•� SF�I� NPE Demolition �) Sign TYPE u New p5j Gas <br /> Sprinkler U RepaidMainl U Othe, <br /> CONTRACT PRICE OF WORK 70/Da o CITY OF EVERETT LOCAL SALES TAX CO�E IS 310Ci <br /> WORK DESCRIPTION <br /> ,��, SF� �;��� 1�`f�3C� . <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM � N0. TYPE OF FIXTURE OR ITEM <br /> 3 WATER CLOSET(TOILET) — A/C—A/HANDLING UNITS <br /> � BATHTUB �s N E✓� I FOP,CED AIR SYSTEMS <br /> LAVATORY(WASH BASI?1) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> 1 KITCHEN SINK& DISPOSAL � CLOTHES DRYER <br /> � DISHWASHER � RANGE HOOD <br /> — LAUNDRY TRAY I bVATER NEATER <br /> _� CLOI"HF�WASHER METAL FIREPLACE/STOVE <br /> — URINAL � FIREPLACEINSERT <br /> _ DRINKING FOUNTAIN � GAS FIREPLACE <br /> FLOOR DRAIN I GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> � SINK(SERVICE/BAR/MCP/ETCJ � EXHAUST FAN <br /> UTHER UTHER <br /> �— , <br /> I <br /> � <br /> i j <br /> j I HEREBY CERITIFV THAT I HAVE READ AIJD EXAMIIJED THIS APPLICATION AND KNOW THE SASIE TO BE TFUE AN�CORRECT. ALL I <br /> I PROVISIONS OF LQWS AND ORIDINACES GJ'✓ERNING THIS TYPE OF WORK WILL BE COMPLiED WITH�VHETHER SPECIFIED HEREIN OR I <br /> i NOT. THE GRANTING OF A PERtd1T DOES NJT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> ' STATC OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY 7HE � <br /> OWNER OF THIS ROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS M1IADE AND I COMPLY WITH THE SThTE I <br /> CON ACTORS W 18.27 RC6V AND 296.200 WAC. I <br /> Sign�ture OwnedContracronAuthorized Agent J �/0/v� <br /> ��Z <br /> DEBIT 8� CReDIT CARDS ARE NOT ACCEPTED I <br />