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� P�tRMIT APPLIGATI�N <br /> i CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STr�EET, EVERETT, WA 98201 <br /> 425•257-8610- FAX 425-257•8857 <br /> ISITE A�DRESS PARCEL TAX I.D.M ERMIT• <br /> aoqE, �s;�� �c� 5�,�-c D ��59a7-00000i -o i ��b� �D�- <br /> LEGA LOT NO. BLOCK TRACT A ` <br /> DESC. j� 'SI� 32� Z �,01�' 2 TOS�kN�C KRIr Au'< �..^'�i+'� T"a� <br /> OWNER�"V�re v1 � 1'r�(� ADDq�SS p <br /> pe.(iok �S3zo S'ec�,l�t 95/0?-%32� �c(, -�3G$- 3313 <br /> TENANTNAME CONTACTNAME PHONE <br /> 1/� �e�-n4 w�'.5 (J.� /i f'lua �9 4o yzS - �'io -loS�� <br /> ONTRACTOR ADDRESS ZIP CONTR.LICENSE N <br /> ��n�Py iZe�lly �„sfi����,�„�t R�' c3oxu��l Sc9h��s�' q�O�-L RA�vp`(G �o►oo l <br /> P��o4 - �sy-5« . <br /> PROPOS D USE OF BUILOIN6 � Building MeChaniCel !Jtlition MEAT SOURCE <br /> Y���„r�`-1L PERMIT Combinetion RI.-( Plumbing WORN Alleratlon p�q( Bectric <br /> �� � TYpE Demolilion U Sign TYPE New �j Gee <br /> Sptlf7klef Repair/MamL LJ Other <br /> CONTRACT PFICE OF WORK �� Z 2Q CITY OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> �VORKDESCRIPTIOfI ��e.Hp�/P� 4Ki�;ti S�Y(fQ fe/ p�Q�i� rQ$ �� Oc�/�y" .�i�rc�►�,� <br /> l.�ti��5. A1f.J C2i/�;y �Yi�{ �e�.J Ji�y� F7vcw �+'�<. /•l✓/�C� �i�+tl�4� !o inS��nf', <br /> g, �'lls �� hcw c�� /�hy c�r��(! <br /> PLUMBING MECHIlNICAL <br /> NO. NPE OF FIXTURE OR REM N0. TYPE OF FU(TURE OR ITEM <br /> WATER CLOSET __ A/C-A/HANDL�NG UNITR <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP <br /> I _ SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 D�SPOSAL _ CLOTHES ORYEFi <br /> I _ DISHWASHER __ RANGEH000 <br /> I = LAUNDFY TRAV = WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> I _ UPINAL _ FlREPLACE INSEPT <br /> i _ DRINKING FOUNTAIN _ OAS FIF6°LACE <br /> i FLOOR DRAIN _ GAS RANGE <br /> � BACKFLOW PREVENTER _ GAS PIPING <br /> � SINK(SEFVICEiBAR/MOP/ETC.) _ EXHAUST FAN <br /> � — OTHER <br /> � OTHER — <br /> I — <br /> iI HEREBV CERITIFY THAT I HAVE READ AND E:AMINED THIS APPUCATION AND KNOW THE:iAME TO BE TPUE AND COf�RECT. ALL <br /> PROVISIONS OF IAWS ANO ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMI7 DOES NOT PFiE5UM17E TO GIVE AUTHORITV TO VIOLATE OF CANCEL THE PROVISICN OF ANV OTHEP <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHf.'HI2ED BV THE <br /> OWNER OF THIS PROPERTY TO PEFFOPM THE WORK FOH WHICM APPLICATION IS MADE AND I COMPLY WITH THF SfATE <br /> � CONTRAC 5 LAW 18.11 RG ANU 296.20 WAC. <br /> Ii '?7—U <br /> ISi ure neri onlraclorl o zed Agent ate �/� <br /> Prc. ls'�4'-✓l�1I,�-�/ _ <br />