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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES /1 - )q--05 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 " !/ 1/6 <br /> SITE ADDRESS PARCEL TAX I.D.# rPERMIT# <br /> CYCjr ' Ycr kP-ctlI ec lw-o C)GLI ci l" I! Cc-6(-(-PniaQcsO-1-0(i <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> r \l.hOIVllsh Co Crzp, IA'IIiii.1-1 3(scfr, , Zc( 6,k U-Rf. (-N,u. '-1 2c l <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> i WIjvl (3 dG •! rCly • ' c <br /> �- 1�� �•� , �r pct v ►2,�5 � �c-��3��, i�i <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> NV--k_( %RS y CO,On tomtA-/ SUOS cod 4/-).0-` 3 Mc_K.x7,-•`7)-72I 9 <br /> PHONE � CJ`-jC <br /> SP c1 A-N 3 I f <br /> PROPOSED USE OF BUILDING Building D Mechanical Addition HEAT SOURCE <br /> PERMIT Combination Plumbing WORK c -Alteration (l Electric <br /> AV"CV) TYPE Demolition Sign TYPE NewLr-(}' Gas <br /> "Sprinkler RepairiMaint. Other <br /> CONTRACT PRICE OF WORK I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION - <br /> le'-r0 64... <br /> t Com-+ r( orx• 04- oX k S'A tVci f�lArj • .okekt_ ��- 70 -SPriv`fc/v: <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT.'UMP <br /> - <br /> SHOWER UNIT HEATERS ' <br /> KITCHEN SINK&DISPOSAL i CLOTHES DRYER <br /> - <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY=om. CLOTHES WASHER t(Y HEATER <br /> �j/ METALFIREPLACE/STOVE <br /> y URINAL �J�1 FIREPLACE INSERT ,� )ci <br /> DRINKING FOUNTAIN V GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE ',i <br /> i\ily)10 <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> iOTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK 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 PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />..e., <br /> , <br /> `, CONT ,CTORS LAW 18.27 RCW AND 296.200 WAC. <br /> "t7h///(AZ' tga-", 121." ar.34 -- <br /> Si ure of Owner/Contractor/Authonzed Agent Date ' 1 <br /> 1 <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED ? ✓ <br /> ._._ ._ <br />