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- ---- u N , ,- �s <br /> PtRMIT APPLICAT�ON ''`�-` "S7�'� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT x �. <br /> 9�Z ' 7N Darvt- �J � :v31z — �-1� <br /> �_EG:,Li LOT NO. BLOCX TRACT <br /> ��sc.r IG �tGus,�1 t,•��eo.i <br /> OWNER ADDRESS ZIP PHO� <br /> /+ ( (yza 3s� -�/auo <br /> ��,��T ��w�tL�� �LaCY!S ,.rnlL . �01) o,Y /S'J'9 .JnJnFi�w1,�F/� cJA q5�'—h� <br /> TENANTNAML CONTACTFORPERMIT � PHONE <br /> CONTRA�TOR � ADDRESS ZIP CONTR.LICENSE# <br /> �.���- r0 vo�( /.5'7y � �NU/�u+"11 SN� u)/i '��'�`j� c.��rr�v�t �cv35-m 3 <br /> PHONE <br /> ��(zS"� 3.ti 3 -yvou CKP �i/zo L:�•s <br /> PROPOSED USE OF BUILDING Buildlflg Mechanical Addilion HEAT SOURCE <br /> / PERMIT Combinalion � Plumbing WORK Alteration (� Jectrvc � <br /> r��Z,,; 1-/cu,Sc C JiJSi7_'b�E'!'t' l'YPE Demoliti0n Sign TYPE New Gas . <br /> v �-�`, Sprinkler RepainMa�ni. � Omcr �. <br /> CONTRACT PRICE OF WORK �$ �5�v 00 CIN OF EVERETT LOCAL SALES TNC COOE IS 3705 <br /> WORK DESCRIPTION <br /> �S �h �S� Si �' � zz_�(3 � <br /> PLUMBING MECHANICAL <br /> NG. i TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM �, <br /> .3 I WATER CLOSET (TOILET) � A/C—A�HANDLING UNITS <br /> 2_ BATH?UB I FORCED AIR SYSTEMS <br /> �3 I LAVATORY (WASH BASIN) HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> � KITCHEN SINK 8 OISPOS.�L _� CLOTHES DRYER , <br /> �' 1_ DISHWHSHER � RANGE HOOD <br /> LAUNDkY TRAY 1_ WATER HEATER <br /> _L CLOTHF.S WASHER METAL FIREPLACE.�STOVE <br /> UFINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN 1 GAS FIREPLACE <br /> � FLOOR DR.41N / GAS RANGE <br /> ! BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/BAR/MOPIETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> — —I <br /> . .,,EREBY CERITIFV THAT I NAVE READ AND E;<,QMINED THIS APPUCPTION AND KNOW THE SAME TO BE TRUE 4ND CORRECT. ALL <br /> =ROVISIONS OF WWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED`NITH VJHETHER SPECIFIED HEREIN OR <br /> tiOT THc GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCcL THE PROVISION OF nf:Y OTRER <br /> ST:.TE OR LOCAL L:.41'REGULATING CONSTRUCTION OR THE PERFORMANGE OF CONSTRUCTION. THAT I Atd AUTHORIZED BV TNE <br /> O::NER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICN APPLICAT;ON IS MADE AND I COhiPLY`:VITH THE STAT'c � <br /> CJNT :TORS LA�4' .27 RCl'J ANJ 296.200\NAC. <br /> � ` <br /> �i <br /> :�.._� /L�i�+/0 3 <br /> S�cnature of �wnedContractor/Authonzed Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED � / <br /> -- — -7�-- <br />