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� <br /> PERNiiT APPLICAT90N <br /> a, CITY OF EVER�TT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERF_TT, WA 98201, 425-257-8810 <br /> SITE ADDRESS PARCEL TAX i.D.N PERMIT� <br /> �Z2 �� 3�=h STi�.� � vv�ao9-on3 . <br /> LEGAL LOTNO. BLOCK TRACT ! <br /> DESC. <br /> OWNER �..�. � ,Z�iVU�STir��2Ts � ADDRESS p � ��q x llri I PHONE <br /> {y2s)z5� �663 <br /> l,(��.q� � �v���.t,C . LvA q� 2�/ � <br /> TENANT NAME CONTACT YAME I PHONE <br /> PI� (n k�NG F3 �4 �� N.�ssA ,� A- L.9 ���i�-e i `/2)"- 2S�'- % Y� <br /> CONTRACTOR � ADDRESS I CONTR. LICENSE# <br /> � I <br /> � <br /> PHONE I <br /> i i <br /> PROPOSED USE OF BUILDING 5uilding � Mechanical 4ddition HEAT SOURCE <br /> PERMIT R Combination Plumbing WORK � Aueralion � Electric <br /> TYPE D Demolilion Sign TYPE New Gas <br /> � � � � �� Sprinkler Repair/MainL Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLIIJG UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOF DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(:'ERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER __ _ OTHER <br /> — _ _ �_ 1��fA Ov[TN3 � �AS <br /> I HEREBY CERITIFY THAT I HAVE READ AND EX.IMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PFOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEiHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUAIE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW RE6ULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM TH�WORK FOR WHICH APPI.ICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 29620J WAC. <br /> `-'- `-�_�"_� <br /> �_-(T-- _-� Sry'T � /d � � <br /> SignaWre of Owner/ContractodAulhorized Agent Date <br />