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l <br /> pERMIT APPLICATI'�N <br /> '' s1z - �r "�� CITY OF EVERETT PERMIT SERVICES <br /> "C��7/�u �e�"� "� �"'� 3200 CEDAR STREET, EVERETT, WA 98201 <br /> R- 5 s/4�i o / 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS � O L /�•�`J[E� M� PARCEL TAl(I.D.q P RMiT a <br /> E� _ � �2 �03/0-D� <br /> LEGA LOT NG. BLO� �< TRACT <br /> I OESC. <br /> OWNER ��REgg /Q/7 w- NI!/lF�PJ�O-✓ ZIP PHONE <br /> � - Ja< ' 9i9a/OI <br /> pE�vn/�l f1�/lwFoRo _f<-�fTJEt�.A �'(//(I /t- a., _ _ i .iiz ._ <br /> TENANT AME CONTACTF�RPEHMIT �.i1�� _ ��J, PI�ONE <br /> I"8�?Nn " a wt ,�.� �� - 2 S-5�9�/0� <br /> CONTRACTOR ADDRESS TIP CONTR.IICENSE K <br /> SM �nr �o�rrrv�no,✓ io92r- zi=rUA. J,E. C-/�/.Si`+l <br /> PNONE <br /> �1S- j j�076� f=.�r-aErr� w 9 zC8 — <br /> � PROPOSED USE OF BUILDING fl Building n Mechanical I"'� Addltlon HEAT SOURCE <br /> I PERMIT K Combination KX+ Plumbing WORK �� Alleratlon � Elecfric <br /> TYPE (_� Demolition V Sign TYPE �_� New Gas <br /> � U Sprinkler Lr Repair/Malnt. Olher <br /> I <br /> CONTRACT PRICE OF WORK CITY OF EVERETf LOCAL SALES TAX CO•�E 19�tOS <br /> WORK DESCRIPTION � <br /> IRFPt�<�rO / Ncr wA7�? /IF-lTxI2 �Al' � <br /> I <br /> i <br /> iPLUMBING MECHANICAL <br /> ; NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF F�XTl1RE OR ITEM <br /> I WATER CLOSET(TOILET) A1C–AIHAtJDLING UNITS <br /> � _ BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> i I _ SHOWER _ UNIT HEATERS <br /> i _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> � _ LAU�dDRVTP,AY L M TALFIREPLACE/STOVE <br /> CLOTHES WASHER — <br /> �' URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> I FLOOR DRAW _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPLVG <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBV C[RITIFV THAT I HAVE READ AND E,`NMINED THIS APPLICATION AND KNOW 1"HE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF lAW 5 AND ORI�INACES GOVERNING THIS TYPE OF WORK .lILL BE COMPLIED WITH WHtTHER SPECIFIED HEREIN OR <br /> HOT. THE GRANTIIJG GF A PERMIT 70ES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROV;SION OF ANV OTHER <br /> STATE OR LOCAL LAW REGULNTINv CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM A4THORIZED 9Y THE <br /> OWNER OF THIS PROPERTY TO P�:I:Fl Rfd TI�E WORK FOR�NHIf,H APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> , CONTRA W 18. RCW ANU'�iu.2 6 W C. <br /> i � � <br /> /� �Q QC`/ � -3 <br /> I � <br /> Signawreo Uwn Mr � hoize gent ate <br /> � D BIT 8 CREUIT CARDS ARE NOT ACCEPTED <br />