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�cRMIT APPLICATI�IN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425•257-8857 <br /> SITE ADDRESS PARCEL TA%I.D.I PERMR• <br /> ��oo z ���so� P.p B na aa-oa <br /> LEOA LOT NO. BLOCK TRACT <br /> oesc. 7Z �uRn� ��S W 5 <br /> OWNER ADDRE38 ZIP PNONE Z�-��-�2J <br /> Rlc.1� R�t� �t�ls �ooz cJ�n.co�.1 j�p �Uutf�2t�tT 4�z,�3 <br /> TENANTNAME I CONTACTNAME PMONE <br /> CONTHACTOR ADDRE38 ZIP CONTR.LICENBEN <br /> �� �ff�OhJ�sl�t� Rox � u�4�� �u.,r2�IT" 9J?�c� <br /> PHONE �z�-- 7S�-3U$� <br /> PROP08ED USE OF BUILDINO Bulldinp � Mechanical Addltlon MEAT 80URCE <br /> PEqMIT Combinetlon Plumbing WORK R Attaretbn f� Etectr�c <br /> �j�14{2IyG'� TVPE Damolitlon Sign TYPE R New Dee <br /> Sprinkler(N of heada) V RepelrlMelnt. B o�,a, <br /> CONTRACT PRICE OF WORK� �CT'OF EVERETT LOCAL SALEB TA%CODE IS 7106 <br /> 9i 7/ — <br /> WORKDE8CRIPTION GUKST1Ll9-CZ'�p�p� �} z�(`�(3L(� <br /> w�o �n�ur c7n� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF fl7(TUqE OR ITEM NO. 1YPE OF fl%TURE OR REM <br /> _ WATERCLOSET(TOILET) A/C-A/HANDLINOUNIT3 <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNITHEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANQE HOOD <br /> __ LAUNDRY TRAY _ WATER HEATER <br /> __ CLOTHES WASHER _ METAL FIREPIACE/5TOVE <br /> __ URINAL _ FIREPLACE INSERT <br /> _ DRINKINO FOUNTAIN _ OAS FIREPLACE <br /> _ FLOOR DRAIN _ OAS RANOE <br /> _ BACKFLOW PREVENTER OAS PIPIN(3 <br /> _ S�NK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORAECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES OOVERNINO THIS 1YPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO OIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEH <br /> STATE OR LOCAL LAW REQULATINO CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOPM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> C ORS W 18. 7 RCW AND 288.200 WAC. � <br /> u �f P_.I� r�,` �4.-u3 <br /> Sgneture of Owner ontractor/ uthonze gem ete �.,� <br /> ( �/a <br />