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� F _RMIT APPLICATI _�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> �925-257•8810- FAX 425-257-8857 <br /> I <br /> '� SITE ADDRE55 PARCEL TAX I.D.M PERMIT M <br /> � �3 Do-3935-Go0-�3Z- OZ Boao� -oa� <br /> LEGA LOT NO. BLOCK TRACT <br /> oesc. � txo-D-oz ,8evf2/ •�/a r�r�e �i'li / <br /> OWNER ADDRES ZIP PHON �Z�J <br /> GRey /Vf����✓ /3 w • C'cts.'�vo �.� Eve,eett GU�9- 9�'aoG 3s3- 6yoS <br /> TEN TNAME CONTACTNAME PHONE <br /> I ✓�'rn 6 u �'�v�v c ya s> ,�y 3 - �a-ss� <br /> CONl nACTOF AD�RESS ZIP CONTR.LICENSE N <br /> .—oc�,�� cou�/�st,� t� �z� Nwy !9 srEa �a„v�vaaao( T°w,✓cfirn99cT' <br /> d' <br /> PHONE QB�a� � <br /> ( �zs;) �'f3- /SSS <br /> PFOPOSED USE OF BUILDING I �t Building ("1 Mechanicol I f� Addition I AT SOUR <br /> �q,Qqp PERMIT 1-� Combinat�on �-� Plumbmg WORK K Allnrallon E nc <br /> [7 e�c ht d z� e • �--c i-r �r <br /> TYPE �j Demolilion L./ Sign 7VPE Q9 New s <br /> u Sprinkler L� Repair/Meint Oth <br /> CONTRACT PRICE OF WORK � (a�t.� '} CJ 44.. � CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION <br /> coNs;R,c,,cT onre �lc��.c...lncd �� s� �aw..� <br /> � qeage. <br /> PLUMBING MECHANICAL / <br /> NO. TYPE OF FIXTURE OR ITEM TVPE OF FIXTURE OR ITEM <br /> j _ W R CLOSET C–A/HANDLING UNITS <br /> ' 8.4TH F CED AIR SYSTEMS <br /> I _ LAVATOR WASH BASIN) / _ HEA UMP <br /> SHOWER UNIT H TERS <br /> j _ KITCHEN SINK 8 ISPOSAL CLOTHE RYER <br /> , _ DISHWASHEF _ RANGE HO <br /> LAUNDRY TRAY j WATER HEAT <br /> CLOTHES WASHER METALFIREPLA STOVE <br /> I _ URINAL /" _ FIREPLACE IN RT <br /> ; _ DRINKING FOU�PAIN GAS FIREP CE <br /> _ FLOOR DRAIH GAS RAN <br /> '� f3ACKFLOW�REVENTER GAS PI G <br /> SINK (S@AVICEiBAR/MOP/ETC.) EXH ST FAN <br /> _ OTH f( _ OT � <br /> —7 — <br /> ' �– <br /> / <br /> I HEREBV CERITIFV'HAT I HAVE READ AND E%AM�NED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AN�CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACC-S GOVERNING THIS iVPE OF WORK WILL BE COMPLIED WITh:WHETHER SPECIFI[D HEREIN OR <br /> NOT THE GRANTING OF A PERMIT OOES NOT PR[SUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION UF ANV OTHER <br /> STAT'c OR LOCAL LAW REGUTA G CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THI ROPERTY T �ERFORM THE WORH FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACT S W 18.27 PN�29fi.200 WAC. <br /> � � __ .�_ ! 2 O [ O � <br /> S�gnaWre ol ner ontractor/Aulhonzed Age ate �/ <br /> ' _ � <br />