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PCRMIT APPLICATIt�rl <br /> CITY OF EVERETT PERMIT SERVICES ��1.�� •t� <br /> 3200 CEDAP. STREET, EVERETT, WA 98201 (�,���- <br /> 425-257-8810- FAX 425-257-8857 r� <br /> SITE ADDRESS PARCEL TAX I.D.A PER tt <br /> �c�.� ic �'�� �� � �� oc�3` 7on���os�-c�9 I � 5� � S <br /> LEGA LOT NO. BLOCK ?Rl,CT <br /> DESC. S :[ � �� �, 1>T��Ii7��A ✓ ?"��tin�S � <br /> OWNERSTL" V/- �I�A/DSU/=� ADDRESS �P PHONE <br /> �3/5- sTPUrt,rYl.t k��a�� l( U�4 DlZ ( .(2�') 7S�1- Zo'7Z <br /> TENANiNAME I CONTACTFURPERMIT PNONE <br /> CONTRACTOR AODRE55 ZIP CONTIt.LICENSE M <br /> s�u,�ni �a/�,yN1n'Ui� Crv�s.� 4��7�4-Zo7Z <br /> PHONE �'rF_�rE.SLo s"�k� <br /> 43�s s�r�2��u�u+ c <br /> PROPOSED USE OF BVLLDING dinEy�_, fl Mechanical Addllion I HEAT SOURCE <br /> PERMIT mhina w �H Plumbing WORK ation c <br /> TYPE � i ion V Sign TYPE �New Gas <br /> 'g�7s J� Spflnkl9f Repair/Mainl. ther <br /> —� "`� <br /> CONTRACT PRILE OF WORK i,�'��� CITV OF EVERETT LOCAI SALES TAX CODE IS 7706 <br /> WORK DESCRIPTION ' /J . �/ <br /> iVCt,J j�� ��l,3SS� �- �L� J�„-(.FJ'�i /LV <br /> � G�}�L'- �7 '/it <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> WATER CLOSET (TOILET) /// A/C-A/HANDLING UNITS ', <br /> BATHTUB I i � FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) /��/ HEAT PUMP <br /> i SHOW[R � UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> _�_ DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAV � WATER HEATER <br /> �_ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> �� DRINKING FOUNTAIN GAS FIREPLACE <br /> � = FLOOR DRAIN � GAS P,ANGE <br /> BACKFLOW PREVEKTER GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) � EXHAUST FAN � <br /> '� OTHFR OTHER <br /> — — I <br /> _ i <br /> � <br /> � ! HEREBV CERITIFV THAT I HHVE READ AND E.tAMINED THIS AFPUCATION AND KNOW TNE SAME TO BE TRUE AND CORREC'f ALL � <br /> 1'ROVISIONS OF IAWS ANC ORIDINACES GO ERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHFTHER SPECIFIED HEREIN OR ! <br /> NI�T. THE GRANTING OF A PCRMIT DO N T PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER �� <br /> STA7E OR LQCAL LAl GULATING N$ RUCTION OR THE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE � <br /> U'.VNER OF fHiS Pqt - TV TO PER OR�11 �HE�YORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS 1827 RC�V AN 29fi.'� U�VAC. <br /> `�, <br /> � Signat wn ontractori ul onze gent � Date , <br /> � <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED IZ I <br /> � <br /> _ _ ----- - - �r--._ � <br /> �� ... ��,c�., ��2�45' <br />