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P RMIT APPLICATI� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> 29r�3z�'�23rnsa� <br /> SITE ADDRESS PARCEL TAX I.D.fl PER���� <br /> `,� g0 � v�a�wa ' �q2qo5- 3 - 005 - o� Ls� � <br /> D SC. LO;� � �I� o�3K TRACT�•�' SINCS �GY� TGtc,IS <br /> OWNER / AUDRESS ZIP PMONE <br /> I"\ic.�lAe� � l,c�aw�bf � ��� �jYOKat'Wtct�, �V-Q � $7.�1 W2S-7�8- a1'70 <br /> YENANTNAME (1 n CONTACTNAMEn PHONE <br /> � J�L<d"I��tµ'1 I Io�Y,� �1�Q.. I.JOMbS �"�25'��Qi � �77d <br /> CONTRACTOR b �e ADDRESS ZIP CONTR.LICENSE N <br /> Qa�;�� (''� �t�u�`�w'�^-��. {, - pACIFMS033JC <br /> PHONE 13ia7 J�L�1l. (IU¢- 1"�Ar yi��e�6�t'f' <br /> �z�� a-2S- s�ag , �is�a7i <br /> PROPOSE�USE OF BIJII�DING � � BUilding D Mechanical Addition HEAT SOURCE <br /> ��� I 1„!� PERMIT Combina�ion U Plum6ing WORK � Alteralion � Electric <br /> ��'\ � � ���� O TYPE Demolilion U Sign TYPE New Gas i <br /> I / ° / �' �uc� Jn�� Spnnkler Repair/tdaint. Other <br /> (/15P�1 `L2�� <br /> CONTRACT PRICE OF\YORK CITY OF EVEREIT LOCAL SALES TAX COOE IS 3105 <br /> WORKDESCRIPTION ��..l.t-n�� �2XJ�b' U •�•C • h�ncQi.t�A✓ u�� �'Xi�yl„'S �o�L '{sr CR✓' Srt�eS �ol , <br /> 17GVQ ��f a.•..1� 1hS�n �� .2 Ca'f�l. �RS'nL �JLPU�Ar �0 1�4 koukeal 7u �'k�i'7"'� <br /> S�c;Qe Seu�r — � �09�: — <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUflE OR PfEM NO. TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET A/C—A/HANDLING U S <br /> BATHTUB FORCED AIR SY ' MS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNITHEA S <br /> KITCHEN SINK 8 DISPOSAL CLOTH DRYER <br /> DISHWASHER N HO00 <br /> LAUNDRY TRAY �. W ER HEATER <br /> � CIOTHE�WASHEFi _ T FIREPLACE/STOVE <br /> URINAL F�REP E INSER7 <br /> DRINKING FOUNTAIN GAS FIRE CE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFIOW PREVENTER GAS PIPING <br /> SINK(SERVICEiBAR1MOP/ETC.) � EXHAUST FAN <br /> OTHER _ OTHER <br /> � _ � p.��1fa-'�,�v — <br /> � — — . <br /> I HFFiEBY CEfiITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOR�TY TO VIOL4TE OA CANCEL THE PROVISION OF ANY OTHER <br /> STATE OF LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED 8Y THE <br /> OWNEFi OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> V NU.�.u. OX I(�1W t�RCW v 29�C. ,�— ��'C� ' <br /> . � <br /> � Date � <br /> Signature ol 0 vn�lraclodAuthonzed Agent � <br /> i � <br />