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PERNIIT APPLICATI�N <br /> �^�� CITY OF EVERETT PERMIT SERVICES <br /> T'" 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SI7E ADDRESS PARCEL TAX I.D.11 PERMIT M _ <br /> l 411 A�a-roa-TRfl, SP2D4-�JS <br /> LEGAL LOT NO. � BL�CK TMCT <br /> DESC. <br /> OWNER nuot�ss 19�1��-144T",A�.cp���, PHONE jf/L�j • <br /> S �E R�+�-.4 l�o.�:STl�GTi o rJ �/VOOD�ni V�LL�E .WFl • 98C'72 4�-T. S�lb <br /> TENANT NAME CONTACT NAME / PHONE �.I� <br /> RA.�c7s R�.JL� +( 1�iwl�or.I I MAR-�.Ew�E dC.GN.JE�I. Q,Z�L. 12LZ� <br /> COMRACTOR ADDRESS "21P CONTR.UCENSE N <br /> T►.► E 5►lai.1 Fo.GToR�. � r�G. Sl5 -�BTM+ ST. S+vw►Fi�,iro20iB <br /> PH NE �1�1G'{..t1.t..ID \I�/.d. �OO�J3 SIla�F�f3K�ll1g <br /> S •822.. 1 oD � <br /> PROPOSED USE OF BUILDING Building �Mechanical Additio� HEAT SOURCE <br /> PENMIT B Combinatbn PlumbiDg WORK �AlteraWn D Elecinc <br /> TYPE ❑ Demo�ition Sign TYPE New ❑ Gas <br /> U Spfinkler Repeir/Mai�t. U Otlier <br /> CONTRACT VRIC�UF WORK O , �� oo CRY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> C�J <br /> WORKDFSCRIPTION 'NSrPLV �ZJ S�� INT. 1l�LUM�aATE� Ct���1�1et- LE'TTERS <br /> �2 � A�NreJlaS j � 3� �ld �.l- 1LL�lf`�'1. LE �TE25�TS <br /> — b �� S �btaJ�n/4t_L MOU �.l.T6D . ' <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR REM NO. TYPE OF Fl%TURE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> I _ BATHTUB _ fOFCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DRVER � <br /> DISHWASHER RANGE HOOD �� <br /> LAUNbRV TRA'Y WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE ' <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN � GAS FlREPLACE <br /> FLOOR DRAW . GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER � � OTHER <br /> —I <br /> I HEREBV CERITIFY THAT I HAVE READ AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WIIL 8E COMPl1ED WITH WHETHER SPECIFIED MEqEIN OR <br /> NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOUTE OR CANCEL TFIE PROVISION OF ANV OTHER <br /> STATE OR LOCAL LAW REGUL4TM(�i CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTMORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLV WITM THE STATE <br /> CONT .W 18.27 RCW AND ACl <br /> „ <br /> � . � 10 . 02 . <br /> I Signature Owned oNractor/Au orized Agent ete - <br /> � `/z <br /> I <br />