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r - <br /> � F �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 AODRESS PARCEL TA%I.D.# PE IT�C� �� <br /> y� z. s we�Mu2c oa�1-3 �) Ic�Z6�^ IZ � � ` <br /> LEGA L01'NO. BLOCK TRACT <br /> DESC. <br /> ADDRESS ZIP PHONE <br /> OWNER sE1l\ I�4DERWc�(� MALL f31.V�.� STc vo3- <br /> �I�MIE NuNTEl2 qy� e3�. 4LS-��� -S99q <br /> Ly ,v,u�,,�c ,> > w,Q <br /> TENANT NAMF. <br /> I CONTACTNAME PHONE <br /> � M�c H�e� A . 4tnr.�.F � /�RcH�TE't� 3 6`�- Sb �- 1 3 'i I <br /> CONTRACTOR <br /> � AOORESS ZIP CONTR.LICENSE N <br /> PHONE <br /> Buiiding Mechanical Addition I HEAT SOURCE <br /> � PROPOSED USE OF BUIL�ING R n Eleclric <br /> PERMIT RI-( Combination L�( Plumbiny WORK Alteration H Gas <br /> CF �.��C- I TYPE �..j Demolition u Sic�n TMPE RepainMainL Ll Other <br /> I U Sprink�er <br /> CONTRACT PRICE OF WORK '���G � CITY OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br /> OPF�cG RA�}e 2°� F C�T W SThirt '�"� <br /> WORKDESCRIPTION GOroVERT ltd� F�� A�'rs. c�+ � � <br /> �ST F�� <br /> � PLUMBING MECHANICAL ��e��4N `�`� <br /> I NO. TYPE OF FIXTURE OR REM NO. TYPE OF FI%TURE OR ITEM <br /> I WATER CLOSET FVC-AlHANDLWG UNITS <br /> BATHTUB ��7RTED AIR SYSTEMS <br /> � I LAVATORY(WASH OASIN) HEH. PUMP <br /> I I HOWER = NIT HE4TERS <br /> KI HEN SINK S DISPOSAL C THES�RYER <br /> DIS ASHER _ RAN HOG� <br /> LAUND TRAY _ WATE EATER <br /> CLOTHES SHER _ M�TAL FI PLACc/STOVE <br /> FIREPLACE SERT <br /> , _ URINAL GAS FIREPLA <br /> DRINKING FOU IN GAS RANGE <br /> _ FLOOR DRAI�I GAS PIPING <br /> BACKFIOW PREVENT EXHAUST FAN <br /> I _ SINK (SEAVICE/BAR/MO ,ETC.) — 07HER <br /> OTHER — <br /> I HEREBV CEFITIFY'HAT I HAVE READ AND EXAtAINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PaOV1510N5 OF La\NS nN�ORID�NACES GOVERNING THIS IYFE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OF <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOFITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHEFi <br /> STATE OF L AL LAW REGU TING CONSTRUCTION OR THE PERFOR6IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OVINER F H S P OPERN PERFORM THE WORK FOR WHICM APPLICATION IS M11ADE AND I COMPLY WITH THE$TA7'E <br /> CONTFA T R L1 18.D R AND 296.200 WAC. � <br /> - \ � Z Oz '/ <br /> Signalure ol wnedConiraclo ulhori ed Agent Date � Z <br />