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�RMIT APPLICATIGN <br /> CITY OF EVERETT PERMIT 5ERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 —FAX 425-257-8857 <br /> // /9 �l.� �'� - c9 i `� <br /> S�TE ADD ESS PARCEL TAX I.D.• A r"�,enn✓ PERMi7 M ,� <br /> / C'�4s: �os��.a�-,� ar' .' Oo34360�� �i oo� IL- ,�c'�b � ( � <br /> LEQA LOT7NO. BLOCK TRACT -/ �^ -- <br /> OW ER G� OO -Q?� Sx� ���i Olz Sr �(/ dc C� ,7ZJ/�ZFl �.�/, <br /> �/. � S"r' . � <br /> ADDRESS LP PMON y <br /> /�'I�cN�.z- �a.a+�a '��x 3o-i. {.�. ��a�� r�f� S'�oi9 G�) �/9• ���3 <br /> 7ENANTNAME I CONTACTNAME <br /> PHONE <br /> CONTRACTOR ADORE33 <br /> `—�c.uE�.A4E �avs:r�xn��aG "_ c� �a �ac.� RC.% � <br /> �c� �ax3 t. 986,Tr <br /> PHONE <br /> a��,��, w,� �,�s' <br /> PROPOSED USE OF BUILDINO Bullding Mechenical Addlliun MEAT SOURCE <br /> Siti/6la� �,yi�c.� PERMIT Combinalion Plumbing WORK Allerellon n� Electrlc <br /> TYPE Demolition �Slgn TYPE �Naw �J-( Oas <br /> �rS� Aa'7�/C� Spnnkler U RapBlr/Mainl. V Olha� <br /> CONiRACT PRICE OF WORK y$�GO DOb CITY OF EVERETT LOCAL 9ALE3 TAX CODE IS 7f05 <br /> O <br /> WORK DESCpIPTION ' <br /> C.�c�� /=,zaN,�� � ,%�...> �C ��.y� .�-.ti.�y��,a�.c� <br /> �AS� c � �0.3� <br /> PLUMBING MECHANICAL <br /> NO. TYpE OF FlJ(TURE OR REM N0. TYPE OF FlXTURE OR ITEM <br /> _, WATER CLOSET p!C-NHANDLING UNITS <br /> BATHTUB T FORCED AIR SYSTEMS <br /> �{ LAVATOAY(WASH BASIN) _ NEAT PUMP <br /> SHOWER UNIT HEATERS <br /> I KITCHEN SINK 8 DISPOSAL T CLOTHES DRYER <br /> � DISHWASHER � RANGE HOOD <br /> LAUNDfiY TRAY _ WATER HEATER <br /> � CLOTHES WASHER _ AIETAL FIREPLACE/STOVE <br /> _ UFIINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN � OAS FIREPLACE <br /> _ FLOOR DRAIN OAS FANGE <br /> I _ BACKFLOW PREVENTER � OAS PIPINO <br /> _ SINK(SERVICE/BAWMOP/ETC.) � El(HAUST FAN <br /> _ OTHER _ GTHEF_ <br /> I — — <br /> I — — <br /> I ' <br /> ' I HEREBV CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br /> PROVISIOIvS OF LAWS ANOORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPIIED WITN WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUMF.TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION Oq THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> . OWNER O HIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT LAW JB27 pCW AND 298.200 WAC. <br /> i . � / <br /> L�l.�� C� � - /�• oZ <br /> Signature or6wner/ onlractor/ ulhorized Agent ate ��Z <br /> � <br /> s�v77�� � <br />