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— -- �— <br /> P RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SI7E ADDRESS PARCEL TAX I.D.N PERMIT M <br /> 3sio g2o.ani„�,��� 9� 009.373�5 70270D .Sl/-XJ <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS PHONE <br /> ��M �/•�v� ,5 023 C�.�l2n�o�� �'r�tx77� �'Y�sJ2S8-S'y�5 <br /> TENRNT NAI1lE CONTACT NAME 9f2o.T �4zS 1 PHONE <br /> ��'J/L7a���C-�' ( 1it�'oe zs z � �3�y <br /> CON7RACTOR 3�a'5���/ SE�✓�C� ADDRESS CONTR.UCENSE R <br /> /Co Z�Z /3nolJl�-L7-A- ���rij 1-E �Z39 /s� . <br /> PHONrf-���.�30 -li6o /J9/CLC�'••ct:X, w�9' r(�0/Z I p•�T.l' `��P�1 <br /> � <br /> PROPOSED USE OF BUILDING Building Mechenical Additbn HEAT SOUfiCE <br /> PERIAIT BCombination Plumbing WORK Auoration Elecmc <br /> ��y}/(, TYPE �] Demolition � Sign TYPE New � Gas <br /> U Spfinklef Repair/Melnt. Other <br /> CONTRACT PRICE OF WORK p���-5 CI7v OF EVERE77 LOCAL SALES 7AR CODE IS 3io5 <br /> WORK DESCRIP710N Q��a� �-�-`- ��,�.-� �,� <br /> PLUMBING MECHANI�AL <br /> N0. TYPE OF flXTURE OR ITEM NO. TYPE OF flXTURE OR REM <br /> WATER CLGSET A/C-A/HANDLING UNITS <br /> BATHTUB FORCED A!R SYSTEMS <br /> LAVATONY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL CLO7HES DRYER �/ <br /> DISHWASHER RANGE HOOD !/� <br /> LAUNDRY TRAY � WATER HEATER �-J <br /> _ CLOTHES WASHER METALFIREPLACFJSTOVE <br /> URINAL / _ FIREPLACE INSERT <br /> � DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGt <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEHEBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAA1E TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WO(iK WILL BE COMPLIED WITH WHETIIER SPECIFIED HEFEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PNESUME TO GIV[AUTHORITY TO VIOLATE OR CANC�L THE PROVISiON OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTRACTOR iB.27 PCW AND 296200 WAC. <br /> . ;o �3��� � I 1 " c� a l <br /> Signature o wner/Conlraclor/Authorized AgeM Date � ,/ <br /> � �008� '7.o�V <br /> 1�� <br />