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� P�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 S <br /> ..y2- -fJ� <br /> SITE ADDRESS �J v G PARCEL TAX I.D.# PcRM17# <br /> f c,�2 U ooc �6�0� I.s� �Di�U� <br /> LE6A LOTNO. BLOCK RACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> L�'t, N�� (�LG �� 'z7� i�' p� s� iSSAc��+l� �� <br /> TENANT NAME � CONTACT FOR PERMIT PHO� <br /> ��1�� E=���- I 51-�-�►-�'� 2��z 23 i 122 <br /> CONTRACTOR aJJ�`�� 1� G�DDRE� �I �v` �' ZIP CONTR.LICENSE# <br /> � t v7 "f <br /> PHONE iL c�J �_' Z Z-�J IIZZ S � - � I C �+ � �w(��1� f �r� u��)(�(S <br /> PROPOSED USE OF BUILDING Building MeChanical Addilion HEAT SOURCE <br /> PERMIT R Combination Plumbing WORK�Alteration I� Electnc <br /> .� _l TYPE D Der.iolition TYPE New � Gas <br /> -ctl�� U Spnnkler RepaidMaint Other <br /> CONTRACT PRICE OF WORK 6G,�(,) � CITY OF EVERETT LOCAL SALES TAX CODE IS 3'105 <br /> WORK DESCRIPTION <br /> f f� �� �a-'� wA-�L ST C�,JS , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. . TYPE UF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—AlHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> L4VATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br />! URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> II HEREBY CERITIrY THAT I H4VE READ AND EXAMWED THIS APPLICATION AND KNOW THE SAM11E TO BE 7RUc AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVeRNING THIS 7YPE OF WORK WILL BE COM?LIEO WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. i HE GR4NTING OF A PERMIT DOES NOT PRcSU�9�TO GIVE AUTHORITY TO VIOL4TE OR CP.NCEL THE PROVISION OF ANY OTHER <br /> STPTE OR LOCAL LAW REGULATL'JG CONSTRUCTION OR THE PER`rORPAANCE OF CONSTRUCTION. THAT I Ah+.AUTHORIZED 6Y THE <br /> OWNER OF THIS PROPERTY TO PERFORM THe INORK fOR WHICH APPLICATION IS MADE AVD I COMPLY WITH THE STATE <br /> CONTRACTORS L4N"1827 RCIN AND 28"0200 N'AC. <br /> Signature of Own ontraclb uthoriz d Agent Date � � �z <br /> . <br /> ��D BIT 8� CREDIT CAi'2DS ARE NOT ACCEPTED <br />