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r ., <br /> P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PEHMIT# <br /> �// oZ Gvu� rcan/ d✓� k�L9- 003 -005 -o2oL 504oZ�p1� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER PDDRESS ZIP PHONE <br /> .�Q-ina9 l�� ss.�- I I �1z�/ 2oa 1"�' ,¢�c. sc. [�.,r..✓c..o�r� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> 1 1 Sccur ,� t3�.v/t Sfc�c �Lo�� YTs= 776 - 88'35- <br /> CONTRACTOR � ADURESS � tIP GONTR.LICENSE S <br /> B�„y Nco.v co � ,�,,��..a« <br /> f'.o. �'.+X st�5 Y ) �j�„ Nc e 77c.n, <br /> PHONE I�ZS 77L-Q$•3S (.a� SQ"aY6 r <br /> PROPOSED USE OF BUILDING �ng�ilding MechanlCal Additlon HEAT SOURCE <br /> PERMIT .{��( C_ombination �`Plumbing WORK Alteration G Electric <br /> ��.,�,k TYPE � Demolition �Sign TYPE ew �.�j Gas <br /> Sprinkler RepairlMaint. U Othar <br /> CONTRACT PRICE OF WORI$� Z� S'y0 Oo CITY OF EVERETf LOCAL SALES TAX CODE IS J705 <br /> WORKDESCRIPTION �pS�'�FGL C�� Se�F" o�F �VG LC F��/5 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> DISHWASHER R.4NGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW ,REVENTER � GAS PIPING <br /> SINK(SERV�:,ElBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HERE9Y CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW TH�SAME TO BE TRUE.uJD CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDIMACES GOVERNING THIS TYPE OF WORK N'ILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. ?HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TU VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR I.00AL LAW REGULATING CONSTRUCTION OR 7HE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED RV THE <br /> OWNER OF THIS PROPERTY T PF_RFOR HE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THF_STATE <br /> CONTR.4CTORS LAW 18.27 W AN . 0 � <br /> —Z 7-oy � Z <br /> Signatur wn .ontractodAuthoriz.ed Agent Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED ' y O a—(� <br />