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—� <br /> � — — , <br /> P�RMIT aPpLICA�'IUN <br /> CITY OF EVERETT PERMIT SfRVICES <br /> 3200 CEDAR STFEET, EVFRETT, WA 98201 <br /> 425-257-8810- FlJC 425-257-8857 <br /> SITE ADDRE55 �N- PARCEL TAX I.D.p rEaMi7 a <br /> 'y3o /io - S� m o 3o�-n�3 <br /> LEGA LOTNO� BLOCK TRACT <br /> DESC. I <br /> __L_ <br /> OWNER ADDRESS 21P PHONE <br /> L,�2��r��, E��� 73n /Iv �%PLSC 98Zo� 4z1S"-,3�3 -���$ <br /> TENANTNAME I CONTACTFORPERMII PHONE <br /> CONTRACTOR � ADDRES9 � ZIP CONTR.LICENSE p <br /> /��v ��e�J.SQ.✓�cPs .su�� i��3z N��y 99 ��- 9�� /�1ldfNtst 141�N<f <br /> PHONE <br /> <=f-�S'. S/�f D I l l <br /> PROPOSED USE OF BUILDING I Building fJ�Mechanical I Additlon I HEAT SOURCE <br /> � �� PERMIT R Combinalion R elumbing��u �"�ORK �Allerallon � �leddc <br /> TVPE � Demali�ion LJ Sign TVPE New Gas <br /> Sprinkler Repair/Malnt. I Olher <br /> CONTRACT PRICE OF WORK Tj 2 ��/ (St/ CITY OF EVERETT LOCAL 9ALES TAX CODE 19 J105 <br /> �..�., l'7 <br /> WORK DESCRIPTION� � �N f py .� <br /> k�m�>✓� f�rs� i/r'� fIP�'. �91F2I�P��.fei 4L��� l/.�. <br /> �Tti�S"f�C(' �RS ���, (x�s �P�T,use�� ¢ 6,�� G�Jr:rr f/en-l.y-,.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FUCTURE OR ITEM NO. TYPE OF fIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> 6ATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWcR UNIT HEATERS <br /> V.ITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY?RAY � �� WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACEINSERT <br /> DRINKING FOUNTAIN � GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER �� GAS PIPING <br /> SINK(SFRVICE.'BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBV CERI7IFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WURK WILL BE COMPLIED WITH WHETf'ER SPECIFIED HEREIN OR <br /> NOT. TNE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OF CANCEL THE PROVISION OF ANV OTHER <br /> STATE OR LOCAL LAW REGULAi�ING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I Af 1 AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CrQjJ,T�RlACTORS LAW 1827 RCW AND 296200 WAC. <br /> //✓L / � ! A , y�� � ��.5 <br /> Signature of Ownerl ontraZ"orl uthon ed Ag� ate <br /> DEBIT 8 CREUIT CARDS ARE NOT ACCEPTED <br />