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� ERMIT APPLICA�[JN e�� <br /> ��� <br /> CITY OF EVERETT PERMIT SERVICES �l wd <br /> 3200 CEDAR STi�EET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDqESS PARCEL TAX I.D.M PEFMIT M I <br /> :" � 7 /3�o,�Lc.��� C��/-� e . Qa z - , <br /> LEGA LOT NO. BLOCK TRACT � <br /> oEs�. 9 � I <br /> OWNER ADDRESS LP PHONE <br /> 4i ia l 7 /"/ P 4 tJ : J N/7/O 7 tif /16i�.I Y �7$'� � <br /> � rF- r.�NirFis� D �.�'t', .i`/ZS �'i'o���i4lily f'v1 9B?UG ZSB- 2.�4l� <br /> TENANTNAME I CONTACTNAME PHONE <br /> U/.�GrlapjPD �GB ✓ADEN 3G0 -GS'9 - BS'S � <br /> CONTRACTOR ADDRESS ZIP CONTR.LJCENSEM '� <br /> ,r�.r�„� �o.�.rr�n��Tie�v /69io Irra,F�v f'7 Ft.� vD 98223 �.�n�ac '�Os'!LK ' <br /> PHONE '���r I <br /> � /'�a_ 4..�� <br /> ,_'��- ' S. i <br /> PROPOSED USE OF BUILDING Building I""1 Mechanical Addition MEAT SOURCE <br /> PERMIT _{R-�Combination �_� Plumbing WOHK Altera�ion Q Elecfric <br /> TYPE �y Demo'ilion LJ Sign TYPE New �._j Gas <br /> U Sprinkler RepairMtaim. L� Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION f/ � .� r /�� µJ ��� f ��y /� �,� 7'�':',;/,L'L <br /> IJPiiio C. Siti �' li��i C7(!J"' J.: <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OF ITEM N0. TVPE OF FIXTURE OR ITEM <br /> � WAT[RCLOSET A/C—A/HANDLINGUNITS <br /> � pATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> ' DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATEF HEATER <br /> I _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINA� FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SEFVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVEFNING THIS NPE OF WORK WILL BE COMPLIED WITH WN�HER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PFOVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I \M AUTHORIZED BY THE <br /> OWNER OF THIS PROPEFN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOFtb LAW 18.27 RCW AND 296200 AC. <br /> ' .� ������ � �� ,S � � <br /> Signature ot Ow dContracto/Au horized nt D e <br />