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r <br /> -. <br /> � PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425•257•8B 10-FAX 425-257•8857 <br /> ( SITE ADORESS PARCEL TA7f I.D.N PER iT M <br /> 1001 VJ C.�151►�o 'KG� P�(,p6 • 6 OG�31000or�0 00 �� / - <br /> LEGAL 1.0T N0. BLOCK TRACT <br /> DESC. � � <br /> OWNER ADDRESS 21P PHONE <br /> VICfDW/t fM�K How1E OWM4tS I ool W C�lbluo R� �' ��- ¢ys 31s �331 <br /> A�3oG1�Ttor1 �o KoN�wuwski �1Ext�if � W h 98204 <br /> TENANTNAME CON ACTFORPERMIT PHONE <br /> �a.�rt.ea� �n.cet►t�i' zd� 28i �soo <br /> ?�4GtFtG �Wb��JOHcINfo '(L�C.H. <br /> CONTRACTOR ADDRESS 21P CONTR.LICENSEp <br /> `I'b 'gE �'t�`��'►'���� �'S 1'✓I D �t.o L655 <br /> PHONE <br /> PROPOSEO USE OF�UILDING I �uildinc� n Alechani[al I Addilion I HEA1 SOURCE <br /> 1I PERId1T Combination �-� Plumbing WORK �ilcralion EleUric <br /> R� �udOm�N��",� 7YPE Demolilion IJ Sign TYPE � New � Gos <br /> Sprinkle� Repair/Mainl. LJ Olher <br /> CONTRACT PRICE l�f WORK � '�SOO��j0 CITV OF EVERETT LOCAL SALES TA%COOE IS]705 <br /> WORK DESCRIPTIONL� <br /> �7�^J� ���Rc� <br /> '— v PLUMBING D MECHANICAL <br /> NO. TYPE OF FI%7URL OR ITHId NO. TVPE OF FI%TI1RE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> EATHTUO FORCEC AIR SYSTEM1IS <br /> � LAVATORY(WASH BASIN) HEAT PUMP <br /> SH0INER UNIT HEATERS <br /> KITCHEN SMK 8 DISPOSC.L CLOTHES DFVER <br /> DISHWASHER F2ANGE HOOD <br /> LAUNDRYTRAY WATEP HEATER <br /> CLOTHES IVASHER PdETAL FIREPLACE/STOV[ <br /> URINAL fIREPLACE INS[RT <br /> DRINKING FOUNTAiN GAS FIREPLAC[ <br /> - FLOOR ORAIN GAS RANGE <br /> �ACKFLOW PRFV[tJTGR GAS PIPING <br /> _ SINK(SERVICE�BARRdOP!C-TCJ EXHAUST FAN <br /> OTH[R OTHER <br /> ..— --- ------ I — <br /> I HEREOV C[RITIFV THAT I NAV[ RfAD AND E%l�h11NED THIS APPLICATION AND KNOW THE SAh1E TO�E TRU[AND CO�RECT. ALl <br /> PROVISIONS OF LAIt'Sl.I:G ORIDINACES GOVERNWG THIS TYPE OF WORK WILL DE COAIPLIED WITH WHETM[R SPECIFIED HEREIN OR <br /> 1JOL TNE GRAN7ING OF A PEt7�dlT OOES NOT PRESUAIE TO GIVE AUTHORITV TO VIOLATE OR CANCEL TH[PROVISION OF ANY OTHER <br /> STATC OR LOCAL Ll�N R[GULATING CONS7RUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUiHORIZ[D�Y THE <br /> OIYNCR OF THIS PROP[RTV TO P[RFORId TME 140RK FOR ll'HICH APPLICATION IS A1ADE AND I CO'dP'V WITH THE S7ATE <br /> CO TMCTORSL.AIY�e.^'RCIYAtJ0 2 96 200 11'AC. <br /> � _ .?�/l �Io�C� G��.���-�iWc� 03 <br /> Signal �e o Owne oNraclod�uthonzea Agent ale <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />