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� �— <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257•8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT M <br /> � ,le � �e . N�1�1� 1-C�3z_ <br /> LEOA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> Gwvnn �qvQh I � 1 �713 �a; ( �� A� e . 98��3 3y7-7385 _ <br /> TENA NAME CONTACT NAME PHONE <br /> I C{nUG ( GOV�ON ,��-OL / 7 <br /> COMTRACtOR ADDRESS ZIP CONTR.LICENSE/ <br /> �or�vL�c Gas H�. �:„q tNG 3SIS 9�/� j'r. SE, 9g�O,s <br /> P42S- 39? -U.'�97 J _ G✓cYc.� �a. QS ��j <br /> PROPOSED USE OF BUILDINO I7 Bullding q MechanA:el Addnion HEAT SOURCE <br /> PERMIT �—� Combinalion �—S Plum6ing WORK � Alleretion � Eleetrb <br /> TYPE j� Demolllion lJ Sign TYPE Naw Das <br /> LJ Sprinkler Repelr/Malnt. Other <br /> CONTRACT PRICE OF WORK Z/�D — CITV OF EVERETT LOCAL SALEB TAX CODE IS�106 <br /> WONK DESCRIPTION � ,�� � N�W q u3 '��✓^A<< ��' ~ <br /> y� a„ ex�Jf��� ar f�r<<< � �tct <br /> C�aN ,7 � � y-c a rew y�s �`-C/ , <br /> ,� �'1[aT r✓..5 tA 11�a ✓�/S�a�vS. Gai P.��ti� r�,. <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FIXTURE OR REM N0. TYPE OF flXTURE OR REM <br /> WATEfl CLOSET A/C-A/HANDLINCi UNITS <br /> BATHTUB X FpRCED AIR SYSTEMS <br /> _ LAVATORY{WASH BASIN) _, HEA'PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _. RANOE HOOD <br /> LAUN�RY TRAY _ WATEH HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN X pAS FIREPLACE <br /> f FLOOF DRAIN _ OA3 RANaE <br /> BACKFLOW PREVENTER _ OAS PIPINO <br /> SINK(SERVICE/BAAlMOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER — <br /> I HEREBV CERITIFY THAI��HAVE fiEAD AND E%AMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECI. ALI. <br /> PROVISIONS OF IAWS ANp ORIDINACES 60VERNINa THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMiT DOES NOT PRESUME TO OIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTNER <br /> STATE OR LOCAI LAW i7EGUlATINp CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THP.T I AM AUTHORIZED BY THE <br /> OWNER OF THIS PRUPEFTY TO PERFURM THE WORK FOR WHICH APPLICATION IS MADE A�lD I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 2982/00 WAC. <br /> ��� ��0. I/� ���Z7��� <br /> Signature o�bwner/'',onlrector/ uth rite�� ate <br /> I <br />