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PERMIT APPLICAI ION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERET i , WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ALDRESS <br />PARCEL TAX I.D. # I PERMIT a <br />(O 8cf1tl <br />—Cco718IrAio-017 <br />LEGAq LOT NO. <br />BLOCK <br />TRACT <br />DESC. 12 <br />OWNER ADDRESS ZIP PHONE ,p5 � <br />'r) 89�1� STiU� k#49 '5,!57 39a3 <br />RAU 56?Is, PIA 13e/ aDr-A-) <br />TENAIIIT NAME <br />_ <br />CONTACT FOR PERMIT PHONE eloZT <br />Sfin� � <br />r LAr(lu A yv-iaa <br />_you <br />(2`M 6jL 1pZ1b.pS ADDRESS IL'fa ty 6,5-Yh S7-X,E ZIP CONTR. LICENSE# <br />CONTRACTOR I— <br />�` 9B/•f/ <br />2 /OC> � (v irk - 0 "? 3 �� Gciq. 9d'i7/ /QLN>f� <br />,2 <br />PHONE <br />leas- �yv—/a-a7 <br />PROPOSE/D� USE OF BUILDING <br />Building I-j Mechanical <br />Addition <br />HEAT SOURCE <br />�1 QI%PR VID 4V"C//�R',( <br />PERMIT <br />Combination IIL-J(( Plumbinn <br />WORK <br />Alteration <br />Electric <br />TYPE <br />I <br />Demolition Sign <br />T)PE <br />I <br />New <br />a <br />Gas <br />I <br />Sprinkler <br />Repair/Maint. <br />goct <br />CONTRACT F RICE OF WORK ( q, q y C7 Qv <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORKDESCRIPTION 0CA')5-frz(tT J) ecoriRf Pflcol 140/Vl IF K � <br />/u'.Sid+us . �- /yfr �z�PP X 4!/trw)�udg,U/moo l!/ d FR°rirrrf u��1r, y%'xl'ss�o <br />HCt`r wfir/ c L S/Gy [ flW, No - k.-:t>'! • 41)cost fs!-ayirir/ f Ncl Y�+6 <br />j/c///t.'!/ -I 5��.� ! r/rzRrf / CV4ItC Pr,F,r �riNF4l, FY'i5/•r5. <br />PLUMBING MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM P/!) ` f NO. I TYPE OF FIXTURE OR ITEM/ <br />♦) <br />_ <br />WATER CLOSET (TOILET) <br />A/C-A/HANDLING UNITS <br />BATHTUB <br />FORCED AIR SYSTEMS <br />_ <br />LAVATORY (WASH BASIN) <br />HEAT PUMP <br />SHOWER <br />UNIT HEATERS <br />_ <br />KITCHEN SINK 8 DISPOSAL <br />CLOTHES DRYER <br />_ <br />DISHWASHER <br />RANGE HOOD <br />_ <br />LAUNDRY TRAY <br />WATER HEATER <br />_ <br />CLOTHES WASHER <br />METAL FIREPLACE/STOVE <br />_ <br />URINAL <br />FIREPLACE INSERT <br />_ <br />DRINKING FOUNTAIN <br />GAS FIREPLACE <br />FLOOR DRAIN <br />GAS RANGE <br />_ <br />BACKFLOW PREVENTER <br />GAS PIPING <br />j <br />SINK (SERVICE/BAR/MOP/ETC ) <br />EXHAUST FAN <br />OTHER <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICAPON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING O'A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR CAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNER IS PROPERTY TO PERFORM THE WORK FOR WHICH APP_ICATION IS MADE AND I COMPLY WITH THE STATE <br />CUNT CT S 8.27 Y AND 296 00 WAC. <br />�. r3 <br />Signatim of er o actor/Au nzed Agent Date ) <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED I/L " <br />