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F��RMIT APPLICATIUN <br /> CITY OF EVERETT PERMlT SERVICES <br /> 3200 CEDAR STREET, EV' �cTf, WA 98201 <br /> 425-257-8810- FAX �[5-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N � P,ERMIT k <br /> raa u�� 3Ya - 35 - 'q -vo SDZGS -�O(7 <br /> LEGA l0T NO. BLOCK TRACT r <br /> DESC. _ � % ?x] 3u , � Q-f OT EC're �IVIS(D�L <br /> OWNER ADORESS E <br /> lcelry �9. +'►'��ks�► +�r+L /1'Y.<r�S �osar a� n- s� E�-����v"r�" s�a�3.3&-s�7 <br /> �lAr751 LOdOWC LDU�� ��c[�arol �-lOr'fC�v SSc,1Ccl6�; Evrnof� 9��r3 5NS35�-(xsay <br /> TENANTNAME � CONTACTNAME PHONE <br /> Y�elly r�-Ark; <br /> �iu�'ol I�ria-�x I-oop �1�� (Y�'irKS '`/�5 31�- -Rv�3 <br /> CONTPACTOR — � �.� ' ADORESS aP CONTR.LICENSE N <br /> �,�e,c�'�(iUP ux-�i'.��. G(.�.u�Yu.t , G �r.d�-ucn�� a r�� <br /> �/�LtC c nl—' �Q�-[�C. C� / �e-�c.�v-.� <br /> PROPOSED USE OF BUILDIN(i' Building Mechanical Additlon HEAT SOUPCE <br /> ��F���IQl1G( �.c�LtL2.�i:,�l PERMIT R Combinelion Pl�umbing N�ORK B Al�eration � Electric <br /> �hQ� � ���� I TVPE D Demolilion i n TYPE D New Gao <br /> r u Sprinkler U Repeir/Mainl. Other <br /> CONTRACT PRICE OF WORK ' D/� � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> V <br /> WORKDESCRIPTION �_ ���G��� d�d�,��� ���J �� „ 1 <br /> G��C L-zac� oF �20��,�1= . N-� <br /> Ch� Id�ens Spee�►�t�gu Centc�-o�Cve�e-N- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OFi ITEM NO. TYPE OF Fl7(TURE OR ITEM <br /> W�TER CLOSET FVC—A/HANDLING UNITS <br /> BATI�TUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> SI�OWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> UPINAL (�IREPLACE INSERT <br />' DRINKING FOUNTAIN GAS FIREPLACE <br /> FLO^R DRAIN GAS R,ANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/8AR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> 1 HEREOY CEPITIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL ' <br /> PROVISIONS OF LAWS FND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITN WHETHER SPFqFIED HEREIN OR I <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEF I <br /> STATE OR LOCAL L' N REGUWTING CONSTRUCTION OR THE PERFOFMANCE OF CONSTPUCTION. THAT I AM AU7HORIZED BV THE <br /> OWNER OF THIS PROPERIY TO PERFORM THE WORK FOR WHICH APP�ICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC70RS LA 18.27 RCW ANp 296.200 WAC. <br /> � �/a3/�..-- <br /> S' na re ol ner/ ont��odAuthonzed Agent Dale � <br /> i <br /> � <br />