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ERMIT APPLlCAT N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRE3S PARCEL TAl(I.D. N PERMiT N <br /> 3�� _ CAS�Nv R o� �,,�, Q <br /> LEGA LOT NO. BLOCK TRACT <br /> oesc. i3-I -I+ � L p-DD EVr�L�-r� pc.AT <br /> OWNER -�_GLi_ VrN ADORESS 21P Pf!ONE <br /> Zo�,,r9 - 72°i ,�►� s. <br /> - o� c�SZ <br /> TENANTNAME CONTACTFOR PER IT PHONE <br /> � - CLG✓G N IpETE.L GR�v ZOIo 36� 0071 <br /> CONTRACTOR ADDRE9S 21P CONTR.LICENBE N <br /> j�Ru- ST/1FF MrGffAN1G.�C, p (7, (3oX 39370 <br /> PHONE <br /> -36�-ov7� �p g0/3� 207ZN <br /> PROPOSED USE OF BUILDIN6 Buliding MeChanlCel Additlon HEAT BGURCE <br /> EYVfTIN[� - RcTAIL PERMIT Combinatlon RuPlumbinp WORK R Alteratlon Elactrlc <br /> IYPE Demolition I� Slgn TYPF New �R-( Gae <br /> Sprinkler B Repelr/Malnt. Ll Other <br /> CONTRACT PRICE OF WORK � � �D CITY OP EVERETT LOCAL 8ALE9 TAIC CODE IS 7106 <br /> WORKDESCRIPTION REPLAu� OHE INDap2 F2GB �C-2 W17H A N�b✓ FRaEKf� <br /> AH� J✓7DJU2 1�'EMo7T Lcwni�S/H[i �/�J�f, QEfRIt��RArT PiP/NL7 <br /> PLUMBING � MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> __ WATER CLOSET(TOILET) A/C-A/HANOLING UNITS <br /> _ DATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH OASIN� HEAT PUMP <br /> _ SHOWER UNITHEATERS <br /> _ KITCHEN SINK 6 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAv WATER HEATER <br /> _ CLUTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLf10E INSERT <br /> _ DRINKING FOUN7AIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER _ = OTHER f2cE�i2 � <br /> -- — -- IZCHdfT` �NpLN�HLi YH�9 <br /> i I HEREBY CERRIFV rHAT I HAVE READ AND E%AMINED THiS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND OHIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEP.SP'cCIFIED HEREIN OR <br /> I NOT. THE GRANTING OF A PERMIT DbES NOT PRESUME TO GIVE AU7HORITV TU VIOLATB OR CANCEL TFIE PROVISION OF ANV OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTNUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PEfiFORM THE WORK FOR WHICH APF�LICATION I MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> �"'�e A .l< 2n <br /> Signatu e o wnedContractor uthonzed Agent �e <br /> DEBIT 8 CR�DIT CARDS ARE NOT ACCEPTED <br />