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i <br /> � � <br /> I � PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> I <br /> SITE ADDRESS PARCEL TA%t.D.M P MIT M <br /> I o01 Vll Ch5�1�0 �D fyLD6 • 6 OAq-31OOODoO 400 ��%/ 'C��/ <br /> LEGAL LOTNO, BLOCK TRACT <br /> DESC. � � <br /> OWNER AODRESS ZIP PHONE <br /> �rICfDWI� W1R1� How1E DWN�tS f ool W c�fbluoRD if 9� 4y� sls '0331 <br /> A�3oGti'�nort EoKcN��uwski t-��Eff , W h 4b2o4 <br /> TENANTNAME CON LAC�TFORPERMIT PHCNE <br /> I J,A.�(tEGl1l. AN.G41'lE+=r td� 26I '15� <br /> Qku�IG �NbnJeHclNto 'i�c14 <br /> CONTRACTOR ADORESS 21P CONTR.LICENSEN <br /> '�'o 'P� �-�tm I�D '� P>I D pK.o C�SS <br /> PHONE <br /> PROPOSED USE OF OUILDING �uilding n Mechanical I n AtlUition I NEAT SOl1RCE <br /> R � �udom�N��,� PERMIT Combination H Piumbing WORK �� nlleraiion Electnc <br /> TYPE Demolilion �� Sign TYPE b,� New Gos <br /> Sprinklcr X�i Repair/Mainl. Olhcr <br /> CONTRACT PRICE OF\40RK � '1SO0��pp CITY OF EVERETT LOCAL SALES TAl(CODE IS 7105 <br /> —�— <br /> WORK DESCRIPTION <br /> SG� �t"�fY4Cf{�D <br /> PLUMBING MECHANICAL O <br /> NO. TYPE OF FI%TURE OR IIEM NO. TYPE OF FI%TURE OR ITEIA <br /> VJATER CLOSET NC-NHANDLING UNITS <br /> BATHTU� FORCED AIR SYSTEAIS <br /> LAVATORY(WASH OASIN) HEAT PUMP <br /> SH0INER UNIT HEATERS <br /> KITCH[N SINK 3 DISPOS�L CLOTHES DRYER <br /> DISIiWASHER RNNGE HOOD <br /> LAUNDRY TRAY WATER HEAT[R <br /> CLOTHES 1VASH[R AIETAL FIRLPLACE/STOVf_ <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAiN GAS FIREPLACE <br /> FLOOR DFiAIN GAS F2ANGE <br /> �ACKFLOIN PREVLNT[f2 GAS PIPING <br /> SINK(SERVICE�OAR/R10P/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I MEREBV CERITIFV TN�T I HAVF Rf_AD AND EXAh11NED THIS APPUCATION AND KNOW THE SAME TO AE TRUE AND CORRECT. ALL <br /> PROVISIONS OF I.AI45�ND ORIO W�CES GOVERNING THIS TYP[OF WORK WILL BE COh1PLIED WITH l5'HETHER SPECIFIED HfREIN OR <br /> NOT. THE GRANTING OF A P[R'.tIT DOES NOT PRESUAIE TO GIVE AUTHORITV TO VIOLATE OR CAI:CEL THE PROVISIGN OF ANY OTHER <br /> STATE OR LOCAL LAIv R[GULATII:G CONSTRUCTION OR TN[PERfORM11ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> Ol':NER OF TMIS PROPERTv 70 Pf_RFOR'd TNE IVORH FOR WHICM APPLIC4TION IS AfADE AND I COMPLV K'ITH 7HE STATE <br /> CONTMCTORS LAPJ 1 27 RCl'ltd:D,^9G 20 YJAC. <br /> G� . G �CbtJ o3 � <br /> S�gnat re o Owner Com�actor/Auihonzed Agenl Date �/Z <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />