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! <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98207 ��_D7��3 <br /> 425-257-8810-FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT p p <br /> 1 �0 Z e W I � �'e., .!'��a <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS 21P PHONE <br /> US �a��. Cov� . Po .P��C �Zo Se.�,ll��w�l �siii �.�b) 3�1y - y4oS <br /> TENANT NAME CONTACT FOR PERMiT PHONE <br /> US �a�.IC� 1��z ���rell Cao�)a�a-��� <br /> CONiRACTOR ADDRESS ZIP CONTR.LICENSE� <br /> �Jwinell�S �iSu� S���n->>j S�`-i (�'` /k�^cS ��� wPr ,pWiNEVS°I��MS <br /> PHONE - \ ���- C1G/_� R�' �'3� <br /> � 50 �li <br /> PROPOSED USE OF BUIIDING Building � MBChanical Addilion I HEAT SOURCE <br /> PERMIT � Combination Plumbing WORK � Altere�ion I7 ElecUic <br /> TYPE Demolition Sign TYPE New � Ges <br /> Spfinkler RepairlMaint. Other <br /> CONTRACT PRICE OF WORK �5 U�� �U CITV OF EVERETf LOCAL SALES TA%CODE IS 3705 <br /> WORK DESCRIPTION <br /> 1 hS�� o� �� S-e� � ��a��- I �� �✓1�i��o � C.�►1.h ��-c� <br /> �Q ��. W � <br /> PI_UMBING MECHANICAL <br /> 'i N0. TYPE OF FI%TURE OR ITEM NO. TVPE OF FI%TURE OR ITEM <br /> j _ WATERCLOSET _ AIC—AIHANDLINGUNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> I SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACEISTOVE <br /> URINAL FIREPLACEINSFRT <br /> DRINKING FOUNT4IN GAS FIREPLACE <br /> FLOOR DRA�N GAS RANGE <br /> BACKFLOW PRE`/ENTER GAS PIPING <br /> SINK(SERVICE/:3P.R/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAh11NED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT. ALL <br /> PROVISIONS OF LA�VS AND ORIDINACES GOVERNING THIS NPE OF WO�K WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROV�SION GF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOfiIZED BY THE <br /> OWNER OF THIS PROPERTY TD PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WI�H THE STATE <br /> CO�RACTOR�W B�CIN AND 296.2 O�C. � ' � <br /> �n.., � � ���31 �+ <br /> Signatur of OwnerlConiractorlAuthori d Agent Dale <br /> I` <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED �L <br /> 5c3Iv -onQ� <br />