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R6�MIT APPLICATIO� ' <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE AD�RESS PARCEL TAX I.D.N PERMIT M <br /> '=�ki� e �s�Nv ��C�v� 0039"� ._cx,3- oio- a3 C6�{ ► -0/ <br /> LEGA LOT NO.� BLOCK TRAC'T/ / / <br /> OW ER IZU?-c>Z/.dS ADURESS '/�F SF ��F �C � A�P SiC�„2E�� LJH. <br /> /�-�ic./ntZ f/. N„2arz �i C�?.;K ..`'.�oZ /Ju�a...�� /-��4 %t�0/9 C,?�N�� �'�-;��I�3 <br /> TENANTNAME I CONTACT NAME PMONE <br /> CONTRACTO n AODRESS ` Lp CQNTR. LICENSEM <br /> ��.�F�afc`�.i-o%k._.c.no.✓, �c. /���Tc go� �Ju✓qu.,l.n? Jb�� "�wf�eeSQbE .TT� <br /> PHONE <br /> �Zo�o� Sr�•��/�3 <br /> PROPOSEO USE OF BUILDING I Building }SiY Mechanlcal AdAilion HEAT SOUPCE <br /> PEHMIT � Com6inalion•R Plumbing WORK � Allarellon � Electric <br /> TVPE Demolilion L15ign TYPE New Oan <br /> Spdnkler Repai�/Melm. Other <br /> CONTRACT PHICE OF WORK �/�� z Z_/N' CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> r- <br /> WORK DESCRIPTION <br /> � <br /> /�'-`�? l.�ou� /—'tiAME� ��niGer -��aH�v7 rS��-7�.cF. <br /> A� lL ��o <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FI7(TURE OR REM N0. TYPE OF FlI(TUNE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> I 3 BATHTUB T FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIfJ) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL Z CIOTHES DFYER <br /> _ DISHWASHER � RANGE HOOD <br /> LAUNDRY TRA� _ WATER HEATER <br /> � CLGTHES WA�HER _ METALFIREPLACFJSTOVE <br /> i = UfiINAI FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN � pA5 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 CERITiFY'HAT I HAVE READ AND E%AMINED THIS APPLI('ATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTi G OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE qF CANCEL THE PROVISION OF ANY OTHER <br /> ST4TE OR LOCAL AW REGULATING CONSTRUCT�ON OR THE PERFORMANCE OF CONSTRUCTION. TMAT I AM AUTHORI2ED BV THE <br /> OWNER OF Th115 P EFiV TO PERFORM TNE WORK FOR WHIC;i APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> CONTFACTOFS LA 1B.?7 RCW AND 6.200 WAC. <br /> �.-..��1 A�i�E� i/- //-c� <br /> Signawre ol OwnenConlractovAuthorized Agent ate �/i <br />