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P R14�IIT APPLICATI�N <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 TAl(I.D.N PERMIT# <br /> ao�( E4s� �s,Ke ��oa� oos49 �oo000l01 'q 2�1 <br /> LEGA LOTNO. BLOCK TRACT !1 L� <br /> oesc. �jlef i�3�3'�� �ro3�2ti�C N4�� �cr�- �rc.�a� T�ac,�s <br /> OWNEI2 ADDRESS O w �..�1(� P PHONF <br /> E�e✓4ffj-h✓e�� , Z'h� � � `4"ti� aoG -2G9-33i3 <br /> 4 S l�en,fS•�S �}w- N S���t o3 <br /> ,5eaff/�e, w� 98(oy - sa <br /> TE ANT NAME CONTACT FOR PERMIT PHONE <br /> 1�r15Y�eo Mo�}�s 2e4- �.G6 -33f3 <br /> �1641.4 'T�oPa D.. T�a�il� WaY��c �(leti2� l <br /> CO CTO ADDRE39 ZIP CONTR.LICEN9E p <br /> '���°y R,_r!ly Ca.,sfr�� r?o,✓3.x y �c,a�� RAAJUY�-Roiool <br /> PHONE�OG ^�JVQ"YloO S¢wJ�v��W� /� <br /> PROPOSED USE Of BUILDING Building f� Mechanical Addltlon HEAT 90URCE <br /> Lo h��n�n,tu ,f�-O r t PERMIT R Combinatlon �_� Plumbing WORK � Allera0on � ElettAc <br /> �i�' pf���• TVPE D Demolltlon U Sign TYPE New Gas <br /> U Spdnkler RepalrlMaint. Olher <br /> CONTRACT PRICE OF WORK �'�'��. � CITY OF EVERETT LOCAL SALES TAX CODE�S�705 <br /> WORKOESCRIPT�IOnN DG,ytp Qri3�q,� f���,ei�>v 4.4/�Sj ,bvild /9� ef 1'h+ 4ia!( ��oo . l�(q�•c.� <br /> �e�Y�i9 9r�e1�' �v �K�S�i�q ,Ge(�'9a.+..r �qe¢. �IGT ��ue���9• fl�Q•n�wt c�fM/3i�9 WQII <br /> b+.{�.�a,,n fh,'s a-.-r� e X�s F�� SPa a �, <br /> Re-Nfc hoaQ wiN, FFre ��pn���r..� �ndG,. S¢pa�...'�'i nr,� <br /> PLUMBING MEGHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> WATER CLOSET(TO�LET) A/C-A/HANDLINCa UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACEISTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> i HEREBV CERIIIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW TME SAME TO BE TRUE AND CORRECT. All <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIV OR <br /> I NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY CTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BV TM': <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE.4ND I COMPLY WITH THE STATE <br /> CONTFAC RS LAW 78.27J2CW A�96.200 WAC. <br /> // <br /> .h{ � ,� . 3—y—o <br /> Signatur o wner/ oMra /Aulhonzed Agent at� /L <br /> ' r <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />