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i <br /> � �. <br /> ' PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STR[ET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 <br /> SITE ADORESS PARCEL TAX I.D.q PE T a <br /> °���a i - I���'� �r . �� . C�:�, �: ���� � � ���- z <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. 1� \ LUCaAcJI3G7� L- sr��rrs <br /> OWNER ADDRESS ZIP PHONE <br /> Co�o Ce�:-sK , �ac� . , I �1 �� 5����- �P2,�:us /nv , �' -rA,d�rmio Wq. 9 �j29Z <br /> TENANTNAM6 CONTACTNAME _T/ 42S\ PHONE <br /> ;L' /� � ` � CA� G�zc. <br /> [j ,� �,> ��2r�l3CF 33�-5�35 , :3y- 573s 33c-�dz- <br /> � CONTRACTOR AODRESS ZIP CONTR.UCENSE M <br /> PHONE � �w` �' GO �-D L� �U Zj j 1•I Ll <br /> GxP. /.0/LZ/�> <br /> PROPOSED USE OF BUILDING Building Mechanical Atldition HEAT SOURCE <br /> S �, ^ PERMIT Combination � Plum6ing WORK R{-{ Alteration Q _lectnc <br /> i�.� 7YaE Demolition Sign 7YPE Q�.New �,LGas <br /> � Sprinkler(u of heads) L� RepainMeint. U Oiher <br /> CONTRACT PHICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK UESCRIPTION <br /> p��� � � � �o <br /> - <br /> �::���•�. _ zz3� : <br /> PLUMBING MECHANICAL <br /> NO. ?YPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET(TOILET) _ A/C-A/HANDLING UNITS <br /> � BATHTUB '. � FORCED AIR SYSTEMS <br /> � � LAVATORY(VJASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL � C�OTHES DRYER <br /> I � DISHWASHER I RANGE HOOQ <br /> LAUNDRY TRAY I �VATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE�STOVE <br /> URINAL FIREPLACE INSERT <br /> I _ DRINKIMG FOUNTAW _ GAS FIREPLACE <br /> I _ FLOOR DRAIN I GAS RANGE <br /> BACKFLOW PREVENTER � GAS PIPING <br /> I _ SINK(SERVICE/BAR/MOP/ETC.) �_ EXHAUST FAN -"�/ O�l <br /> i _ OTHER _ OTHER , <br /> I = _ = I����1 <br /> i <br /> iI HEREBY CERITIFV THAT I HAVE �EAD �^:C =i:�'.11':cD THIS APPLICATION AND KNO'N THE SAME TO BE TRUE AND CORREGT. ALL <br /> PROVISIO��S OF LAWS AND CRIDI�IACES ":C.==�,.';.: 'HIS TlPE OF'�NORK'NILL BE COM1IPLIED WITH WHE7HER SPECIFIED HEREIN OR <br /> I ?JOT. THE GRANTUJG OF n' PERM1tIT�CG� '.�;' '=iE=�..I.:E TO��IVE AUTHORITY TO VIOWT'e OR CANCEL THE PflOVISION OF ANY OTHER <br /> STATE OR LOCAL�W REGUU7ING C:L _'?�.�•:'�G'1;;P THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORRED BY THE <br /> I OWNER OF THIS PROPERTI TO PERFORt.'� "H� ::ORK =0R'NHICH APPLIC:.710N IS IdADE AND I CO�dPLY WITH THE STATE <br /> ' CONTRfP S LAW 18.2'RC:V A^ID 2�5-»'::=C. <br /> � / ��i��'�' ( /o��3 <br /> ' S�gnawre ot Owner,Contrac�onAuthonze�: Ag��� ' � Date � <br /> � <br /> --- - -- � ----� - t <br />