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P�RMIT APPLICATIG��I <br />CITY OF EVERETT PERMIT SEFZVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 <br />SITE ADDRESS <br />?cni O%�¢S i1uE � �►r.Er( iD». <br />_EGAL LOT NO. <br />�esc. �g�p <br />�WNER <br />�Nu4}�r1�SN <br />BLOCK <br />L�l, taC. <br />u-C�( <br />'ENANTNAME <br />5No4brl►SI� �Nii <br />CONTRACTOR <br />MA. Mo2T�j,ir�-o�4 <br />PHONE <br />PARCEL TAX I.D. # <br />oo4�qo� 15cx�loo <br />7RACT <br />:�PrIaN) <br />So�oE Rc�kl��itLl.�k2 <br />CONTACT FOR PERMIi <br />Lnv+w-^( f�o6Tz <br />ADDRESS <br />14�Iq NE aq'� t�acE <br />13x1.L�vU�, G1A. �Ij3oo� <br />�a��o <br />f# <br />90Ao� �42�5.3ae.3118 <br />ZIP <br />PHONE <br />'�iaCi. A'�.3. S�S� <br />CONTR. LICENSE # <br />Mt.rlo�zG IqON� <br />PROPOSED USE OF BUILDING Budding f� Mechanical Addilion HEAT SOURCE <br />E�GVPJUG O�'�GE pjUOLj, PERMIT Combinalion i_:� Plumbing WORK Alteration 1n--1 Electric <br />TYPE Demolition Ll Sign TYPE New Jty Gas <br />Sprinkler Repair/Maint. l.� Other <br />CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />WORK DESCRIPTION • <br />ATtuil B S'i�t vFfti.t P�UIU01�1G aaniTlUN -to ,�xt57iN4 �o�t� fv. <br />(� g1t��n.'f oF�tct �►xi . <br />NO. � TYPE OF I�IXTURE OR ITEM <br />WATER CLOSET (TOILET) <br />BNTHTUb <br />LAVATORY (WASH BASIN) <br />SIIOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES VlASHER <br />URINAI <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BFCKFLOW PREVENTER <br />SINK (SERVICEiBAR/MOP/ETCJ <br />OTI�ER <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HE,4T PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />I HEREBY CERITIFY THAT I HAVE READ AND EXAAIINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAN'S ANO ORIDINACES GOVERNING THIS T1'PE OF 6YORK N9LL 6E COAIPLIED WITH WHETHER SPECIFIED hEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUAtE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORP,fANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWN�R OF THIS PROPERTY TO PERFORAI THE WORK FOR N'HICH APPLICP.TIOtJ IS M1!ADE 4ND I COMPLY WITH THE STATE <br />DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />/� <br />% <br />