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P�RMIT APPLJCA�'ION <br /> CITY OF EVERETf PERMIT SERVICES <br /> 3200 CEUAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 42F-257-8857 <br /> SITE AD RES pARCEL TAX I.D.# PERMI7 w <br /> 2 � % > > . � a/OC�O � oz�3 0/3 <br /> LEGA �OTNO. LOCK TRACT <br /> DESC. <br /> QWNER fL��/`�t �`fIJIC f«<Y�/fil'S ��DDRESS LP PHONE <br /> ,v,�f ��yzs C�/Gyfl�� �2c-s ��.f 9�Zc� �1�-�s�-�nv, <br /> TENANT NA�dE I CONTACT NAME <br /> PHONE <br /> CONTRACTOR ��� CG�51TIdC�IUi'1 ADDRESS LP CONTR.LICENSEM <br /> Sc',�v'�ce : I n L /54C�S 5�. 37y"S�' S�'-2G0 <br /> PHONE �Z.�J ' T54 �OC�ZC� �ei )e�u� ��o��� FC1[:C'.S� n99N1� <br /> PROPOSED USE OP BUILDING BUilding Q MeChanical Addlllon HEAT SOURCE <br /> PERMIT � Combination u P�umbing WORK R Alleration � Electric <br /> TYPE Demolilion U Sign TYPE D New Gas <br /> Sprinkler U Repair/Maint. Other <br /> CON7 fiACT PRICE OF WORK CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORY.DESCRIPTION , <br /> �.�-f�-,��1151� R��� i�i�,.,�� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> _ WATERCLOSET _ A/C—A/HANDLINGUNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATrR <br /> _ CLOTHES WASHER __ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLAi,E INSEflT <br /> _ ORINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED TH�S APPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT. ALL <br /> PROVISIONS OF Lr1WS AND ORIDINACES GOVERNING THIS TYPE JF WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR <br /> NO7. TFiE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PROV�SION OF ANY OTHER <br /> 57ATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONS7RUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOFM THE WORK FOR WHICH APPLICATION IS MADE AND I COASFLY WITH THE STATE <br /> CONTfiACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> Signature ol Owner/ContractoUAuthonzed Pgent Date ���?}'� <br />