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J �. <br /> I-- PERMIT APPLICATION <br /> I CITY OF EVERETT PERMIT 5ERVICES <br /> i 3200 CEDAR STREET, EVERETT,WA 98201 <br /> � 425•257•8810-FAX 425•257-8857 <br /> iSITE ADDRESS PARCEL TAX I.D.N PERMi a 7 ' ' <br /> � l001 v�1 C��1�01�D P,(,D6 . ti o[a�31000000 00 .�// -G/ � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. � � <br /> OWNER AODRESS ZIP PMONE <br /> V1�TbRlh PNR�►,���H� ow1E oWrP4iS I oot w C�swo Ro iF 9�- 4y5 si3 '�331 <br /> 41 ` Q,f� <br /> A�fJD�+I�I�✓LL EV KPNA�ZIN/SI�I .�� � W ►�" �v W� PNONE <br /> TENANT NAME CON PCT FOR PERMIT <br /> J,a.�R.eat�. /tKu+�T� Zoto Z6� 7soo <br /> ?kGtFIG �Nb/�JCE�CINIo '1�LR <br /> COHTRACTOR ADDRESS 21P CONTR.LICENSEN <br /> -ro � �-�itm I Nea '� i'✓I D �'Lo Ce55 <br /> AHONE <br /> PROPOSEDUSEOFDUILDING � Ouilding D 1lechanical n Ad�dion I IIEATSOURCE <br /> PERIAIT Combination U Plumbing IWORK < < Al�cral�on � Elec:nc <br /> R I eouoomwiK�n rypE Demolilion U s�9n nre jo� New Gaf <br /> Sprinkler YX Ropair/Mainl. Other <br /> CONTRACT PRICE OF WORK � '�sppl Up0 CITY OF EVERETT LOCA!SALES TAX CODE IS]105 <br /> a <br /> WORK DESCRIPTION <br /> Sc-k �4Tf�4cf{E D <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FI%TURE OR ITEIA NO. TYP[OF FIXTURE OR ITEM11 <br /> WATERCLOSET _ A/C—NHANDLINGUNITS <br /> � BATHTUB _ FORCED AIR SYSTEAIS <br /> LAVATORY (N'ASH ��SiN) __ HEAT PUMP <br /> SH0INER __ UNIT HEATERS <br /> KITCH[N SIhK R GISPOS.4L _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRYTRAY _ WATERHEATER <br /> CLOTHES YJASHER _ METAL FIREPLACE/STO\G <br /> URINAL _ FIREPLACE INSERT <br /> � DRINKING FOUNTNN _ GAS FIREPLACE <br /> FLOOR DRA�N _ GAS RAN�E <br /> �ACKFL0IV PREVEt�T[R _ GAS PIPING <br /> SIkK (SERVICE�8/1RRdOP;[1C.) _ EXHAUST FAN <br /> OTH[R_________ _ OTHER`_ <br /> 1 HEHEOY CERI7IFY TMAT I HAV[ RfAO ANO[X4M1tIK[D 7H15 APPLICATION ANO KNOW TME SAME TQ BE TRUE AND CORREC i ALL <br /> PROVISICNS OF LAV:S AK�ORiUINACES GOV[RNING 7NI5 TYPE OF\VORK 1VILL B[COM1IPLIED W''H Lti'HFTHEft SPECIFIED NCREIN OR <br /> S ATE OR LOCAL IIJ�I"lORGGUI.l�1IITG C�O JSTRUCT ON OR THO[[RFORh1oANICE OF CONSTRU T UrN.CTHAT I AM A�UT'HIORI EDABY�EMER <br /> 015'NLR OF 7H15 PROP[R7V TO Pf RFOR�'d TME 1YORN FOR�\'HICH�PPLICATION IS MADE AND I COh1PLV WITH fHE STATE <br /> COt1FLp.:�CTORS LAIY� P7 Rf.1V��.0?96 20D IYAC. <br /> . � G�4.�G,�t,l,��a� 'fo /I.�tJ o3 <br /> Srcnal re o Owner/ oniroctor/Auihonred A9ent a�e �L <br /> /(l <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />