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19 <br /> PERMiT APP�ICATION <br /> CITY OF EVERETT FERMIY SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-25?-8810 — FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERFnIT# <br /> ���lZ2 /G �� 1�R� �. �J, ��� - D I <br /> LEGAL LOTNO. BLOCK TRAC , I <br /> DESC. J�(�{�(,{Si'� WOd.p,� <br /> OWNER ADDRE55 ZIP PHONE <br /> C��y Nv� N Quic�cY1 , itiJG �c7 �oX )S'l� .fnia/{�i.fN wA 98zq�� �zs 3�J-ia�v <br /> TENANT NAME CO�JTACT FOR PERMIT � PHONE <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> G `�= C .�'tSTN�{,�` 0 XS �3 <br /> PHONE <br /> � L�� 3�`1 -(voo i�� /�eX /s'j9 s,voo-lcwi�S�, u//� �J�'Z°// <br /> PROPOSEU USE OF BUILDING Buildlflg Mechanical Addition HEAT SOURCE <br /> PERMIT � Combination R Plumbing WORK � Alteration � Electric <br /> + I�� S-,/�� TYPE Demolition D Sign TYPE tdew Gas <br /> �� � I Sprinkler Repa�uMaint. Other <br /> CONTRA' � PRICE OF'vVORK .� .7o f D� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION I <br /> � I <br /> Nr.`v� SFR �Gt�,�ilL 22�.�� <br /> PLUMBING (v1ECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> WATER CLOSET(TOILET) – NC–A/HANDLING UNITS � <br /> _�_ BATHTUB �srrwQ � FORCEDAIRSYSTEMS � <br /> �_ LAVATORY (WASH BASIN) – HEAT PUMP I <br /> �- SHOWER UNITHEATERS <br /> �. KITChIEN SINK& DISPOSAL �_ CLOTHES DftYER <br /> �_ DISHWASHER _I RANGE HOOD <br /> _ LAUNDRY TRAY �_ WATER HEATER <br /> _� CLOTHFS'�vASHER – METAL FIREPLACEISTOVE <br /> _ URINAL FIREPLACE INSERT I <br /> = DRINKING FOUNTAIN �_ GAS FIREPLACE <br /> FLOOR DRAW � GAS RANGE <br /> BACKFLOW PREVENTER � GAS PIPING <br /> SINK(SEF.VICEIBAR/MOPlETC.) � EXHAUST FAN <br /> I = OTHER _ OTHER <br /> — — i <br /> I <br /> � <br /> I HEREBY CERITIFY THAT I HAVE R65 D i;ND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL '� <br /> I PROVISIONS OF L:iWS ANC OP,IDINAC�S GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR . <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANl'OTHER i <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORA4ANCE OF CONSTRUCTION. THAT I AM11 AUTHORIZED BY THE <br /> OWNER OF THIS PR PERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH 7HE STATE I <br /> CONT�CTORS lA� 1827 RCW AND 290.200�VAC. �� <br /> � � �� � j <br /> Signature of wner/Contracror;Authorized Agent Date I <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED I <br />