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N �7 <br /> � fYlti�l�' l�J J�"IC <br /> P��RMIT APPLICATI�N� <br /> CITY OF EVERETT PERMIT SERV�;;ES <br /> �200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-5857 <br /> SI i E AD�RESS � PARCEL TAX I.D.# PERMiT lt <br /> �'�/3z, /�L� � _ ve �'� Co 3�a -03� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. � �- a�GUS�� LJOOOS' <br /> OWNER DDRESS ZIP P.HON <br /> �y 3s3-yeuo <br /> C�vl-� fyvwtE[3u ��dt,12S �-YnJC • POuo,Y/S7 .I�J erq�J��A �$?i � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR � A6DRESS LIP �ON�L��O$5� 3 <br /> C a�1.� � o �i' oX �S`7y , .SN�,yu� r sr�, �H 9�Z9� <br /> P ONE �XP ��IZ`��t'coS <br /> zs) 3.�3 -9aou _ <br /> PROPOSED USE OF BUILDING I� Building Mechanical Addition FiEAT SOURCE <br /> /' PERMIT �� Combination � Plumbing WORK � Alteration � Electnc <br /> N� �e�s� C �rJSi7''-�k�`t' � 1YPE �( Demolitiun Sign TYPE New Gas <br /> � �� L� Sprinkler RepaidMainL Other � <br /> CONTRACT PRICE OF WORK �6S�0O CITY OF EVFRETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> S F � i��s � c z z �l�{ <br /> �LUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF PIXTURE OR ITEM <br /> WATER CLOSET(TOILET) — A/C—A/HANDL�NG UNITS <br /> 'Z BATHTUB � FORCED AIR SYSTGMS <br /> �_ LAVATORY(WASH BASIN) = HEAT PUMP <br /> SHOWER — UNITHEATERS <br /> � KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> �_ DISHWASHER � RANGE HOOD <br /> _. LAUNDRY TRAY �_ WATER HEATER <br /> I � CLOTHES WASHER �_ METAL FIREPLACE/STOVE <br /> + URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN � GAS FIREPLACE <br /> � FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/�dOPIETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AN�EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL I <br /> PROVISIONS OF LAWS ANO ORIUINACES GOVERNIN,3 THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT 2RESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCP,L LAW R GU�ATING CONSTRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNE F THIS PROP TY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STA7E <br /> CONT CTORS LAW 1 .21 RCW AND 296.2U0 WAC. <br /> / / � <br /> li �� �,•_ 3v o�3 � <br /> Signature of wnedConlraclor/Authonzed Agent Date �� <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED � <br /> � <br />