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P�riMIT APPLICATIG.� <br /> CITY OF EVERETf PERMIT SERVICES <br /> 3200 CEDAH STREET, EVERETT, WA 99201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADORESS PARCEL TAX I.D,� PERMIT k <br /> "' 22 c,�ti' /3VC 4 �oD�io� lcc� <br /> LEGA LOT NO. BLOCK TRACT �(�I M/�-� �'�l(�/.� t!L F1(L/y� �, pn 1 TllS}�I <br /> DESC. �•� <br /> �'� OL-"V= L, o A�� 5 M� 5 <br /> OWNER ADDRESS aP PNONE <br /> r��r�i��1T RA►�in (��C, 3g�� Cot,13�f i�JL=i ��ISl2-�.'1� cl'��I��k�s�n a <br /> CONTACTNAME PMONE T � I <br /> ►-1 `yk I �!a�"� e (' �2. �.� �k2s--�t �- �--i.l <br /> CONTRACTOR ��I� �(�` �� rj� ADORESS G u �}y, LP CONTR.LICENSE M <br /> PHONE "! D IJGVG C/'�"�C� oI� Z I�U� ✓lY�i�iTS,C ' �L' �—`j} �` <br /> ��s 4�3- I 3i 3 _�--r i� cu, u.s p �'�o�� �� �-v. <br /> PROPOSEO USE OF BUILDING wlding I") Mechanical f'� Addition HEAT SOURCE <br /> vf PERMIT Combinetion H fllumbing WORK FL�7Alleralion tF7{,�E_lectric <br /> Q `.�� 1�.(� CU.)�� TYPE Demolition �� Sign TYPE u New v �as <br /> �� Sprinkler U RepaidMaint. L� Othe; <br /> CONTRACT PRICE Of WORK I D I �-a CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTON <br /> I eM�oR�-�.R '( "�O��CT (ZoaJl F�- pUQ-r�Tlorl <br /> U�' COnlSTRuLT�o�( I.�o�IL . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTUHE OH ITEM ND. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWEA UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER _ METAI FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS IiANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> i _ OTHER OTHER <br /> I • <br /> 1 NEREBY CERITIFY THAT I HAVE REAO AND EXAMINEO THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COPRECT. ALL <br /> . PROVISIONS OF LAWS AN�ORIDINACES GOVERNING ThiIS TYPE OF WORK WILL BE COMPIIED WITH WHETHEP SPECIFIED HEFEIN 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 qEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNORIZED BY THE <br /> IOWNER OF THIS FFOPERTY TO PERFORM THE WOFK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTHACTOfiS W 18.27 RCW AND 296 2 W <br /> �� ���ii���r%/�� ��--. ����v� <br /> . SignaW`Pe of Owner/ContractodAuthonzed Agent Date <br /> i <br /> i <br />