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� --- <br /> PERMIT AP�LICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 1 <br /> -- �U,l c�h�- - �os <br /> SITE AUDRESS t � PARCEL TAX I.LI,# P MIT p <br /> �zg ZO ��c�G��2 �J� . 06 4 39 '� C� %�00 ZSD Z I �'��/;� <br /> LEGA L T 4NO� . BLOCK TRACT <br /> oesc. U89i7T x a'Z9 �Y�U �J c�t£'�' Q�,�a�- l�- d 2 <br /> OWNER �wA„`N� ��� �E��� ADDRESS 21P PHONE <br /> cgzfJ� GE'ANY� l�U�z...1lJi:� � c�u<iK��� lUZU� `�Z7 'X��J �� ` <br /> ,� � <br /> TE NT NAME CONTACT FOR PERMIi PHONE <br /> }-� ra�v� �'o.�C � IG�a�e`f i�'r>�c�C���soJ, �4tcl��f*��S <br /> '�'Z�ZsZ 2�5� <br /> CONTRACTOR (' ADDRESS A <br /> � ' - �✓ `q W�JS`1'L�Jf-�7 0�� IG:�I � 1���1C��- ��•� , 21P CONTR.LICENSEq <br /> P�e C`f ` 1 � 1 S�.-� C . �u-enc� `1S(ZOYj <br /> �F�'�1Ct 1�4-K3 <br /> �OPOSEDUSEOFBUILDING I DZfBuilding Mechanical Addition :IEATSOURCE <br /> � ��,� �jy�,,, L� �� PERMIT ���Combinalion R Plumbing IWORK R Alteration I7 Electric <br /> � � TYPE �_,j Demolition � Sign TYPE ❑ New � Gas <br /> S ra�-o �J L� Sprinkler U Rr.pairlMaint. Other <br /> CONTRACTPRICEOFWORK 2� �p� '� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> WORK OESCRIPTION <br /> ln>-��L�u�Z w ✓�1\ ��/r'v4,--� �.,�.� vK �.�oL' \�L,�...Gi.JC� <br /> A�G�J G/�n5✓w. ww�\ (7��iw. •7 �r���oVL WIiNo�t L.Lu��� cqC_ <br /> ►Ue�.a S�s(��-„i✓� �e�L�r�/c, d F'Lar.2 S✓v- �'�ac�5 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> ,_ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOVJER UNIT H[ATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER R,4NGE 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 /> I <br /> i I HERE�Y CERITIFY THAT I HAVE READ AND EXAAfINEO THIS PPPLICATION AND KNOW THE SAME TO BE TRUE AND CO4RECT. ALL <br /> . PROViSIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH N�4ETHER SPECIFIED HEREIN OR <br /> ! NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GNE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br /> ' STATE OR LOCAL LA�Y- ULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRbPER TO ERFORM THE 4VORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRf+CT(�RS LAW 18. RC AND 296.2001NAC. <br /> �/ <br /> i " �l<l --LCI� / L Z.v U�- <br /> nat�of 0 dContracror/Authonzed Agent D e ��Z <br /> � DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />