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. � � <br /> � PERMIT APPLICATION <br /> 1 CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257•8810-FAX 425-257-8857 <br /> � PARCEL TAX I.D.N PE IT p <br /> � SITE ADDRESS <br /> 1001 Vl1 C/Y5�1��R� �6 • 0�''>IOOOOOO oa - �� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. � � <br /> OWNER AODRESS ZIP PNONE <br /> �I CTO flWIK. HO M1E D►NM�tS I Oo I W C�1S W O RU if 9� ,�25 513 '03'3 I <br /> fc-t,o��a��a• �v Ka�+�+wuwsk� �En:eil' � W h 98204 <br /> TENANT NAME CON LACT FOR PERMIT PI10NE <br /> I J,A.f7ftEARI. AKt441T�r 2a� 26l '13� - <br /> P�4Gt�lG !,'IJfol►JeEKINto '7�C1! <br /> CONTRACTOR AODRESS 21P CONTR.LICENSEN <br /> -rb p,,c q�-�itm 1��.D � (31 D pYi.o C.�SS <br /> PHQNE <br /> PROPOSED USE OF OUILDING �uilding Mechani[ol AdJ�lian HEAT SOURCE <br /> PERtdIT Combination R{.-( Plumbing WORK Altemtmn bf"1( Electne <br /> R-I eoudom►NrK�t 7YPE � Demolition U Sign TVPE New yK Goe <br /> Sprinklcr Repad6�aim. IJ Othcr <br /> CONTRACT PRICE OF WORK � '�5op,Qp� LITY OF EVERETi LOCAL SAIES TA%CODE IS J105 — <br /> WORK DESLRIPTION�t� <br /> �J� ���Glc.� <br /> — PLUMBIYG �ECHANICAL <br /> VO. TYPE OF FIXTURE OR IT[M NO. TYPE OF FI%TUR[OR ITEM <br /> VJATERCLOSET _ NC–A/HANDLINGUNITS <br /> BATHTU6 _ FORCEOAIRSYSTEM1IS <br /> � LAV�TORY(WASH OASiN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCH[N SINK& Dicpp;,^,�_ _ CLOTHES DRVER <br /> DISHWASHER __ RANGE HOOD <br /> LAUNDRY TRAY __ WATER NEATE!i <br /> CLOTHES INASH[R __ h1FTAL FIREPLACE/STOVE <br /> URINAL ___ FIREPLACE INSF.RT <br /> DRINKING FOUNTAV� _ GAS FIREPLACE <br /> FLOOR DRAIN __ GAS RANGE <br /> BACKFLOIV PRLVENT[R __ GAS PIPING <br /> SINK(SERVICE/OARRdOP/eTC.) _ E%HAUST FAN <br /> -- OTHER_—____ ____—__ ___ OTHER._—___.___ <br /> I MEREOV C[RITIFY THAT I HAVE READ AND E%lddWED THIS APP�ICATION AND KNOW TNE SAhI[10 f1E TRU[AND CORRECT. ALl <br /> PROV 1N0��NT NG OF A PERID IT�0 5 h0T PRESU�1EIT G V AUTH�OR TV TO VIOIATE`OR CANCEL'1 NCNPROVISION OF ANV OiHER <br /> NOT. <br /> STATE OR LOCAI LA�Y R�GULAT R:G CCNSTRUC110N OR 7NE PERFOft1:.ANCE OF CONSTRUCTION. THAT t A�d AUTHORIZED BY THE <br /> OYINER OF TMIS PROPFRTV 70 PfRFOR'd THE 140RK FCR 1YNICH APPLICATION IS A1A�E AND I COA+PLV 1VITH THE STATE <br /> CONTRACTORS LAIY 1B 77 RCP!l.1:D 796 4001"AC <br /> ��. ��ia-� _G�tiGG.i.�� lo �uo� 03 ^ <br /> Signat rc ol OwncrlC nir�ctot/l�uihonicd Agen� Date �/ <br /> L <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />