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JRN-SS-20f�C, 08:30 FROM:FERMIT 4257756315 -U� 14252578857 P.1 <br /> i <br /> �ERMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 987.01 <br /> 425-257•BB 10- FAX 425-257-8857 <br /> l _ 1/_O6 <br /> 91TE AODRE9S PARCEL 7AX I.D.N PERM{T MD / _l /^ <br /> �r,Z c.e��� ,I'f �OS313DG/o3�d0 rn «� �«� <br /> LEGA LOTNO. BLOCN TRACT <br /> DESC. <br /> OW ER ADORESS 21P PHONE Zp— <br /> �1 e o n�. �,�.,�-f �� z Ced��sf �,� 9Fza i Zr�-��3s <br /> IENANTNAME CONTACiFORPERMIT vHONE <br /> �a �-e� ,(a�1d� yZs 2-rs B�Is-� <br /> GONTR CTOR AD�RESS ZIP GOPITR.LICEN8E11 <br /> w�J'H �►��'l �1CQ1 C��J'yr�fy7ic�y <br /> PHON� �L '7Cv �� ��n- k� ��4��9 9 <br /> PROPOSED USE OF PUILOINO � � Building �Mechanlcal I f� Aadilmn I HEAT SOURCE <br /> reRMIT Combination Plwnbing woRK ��� Alrorauon EbGAc <br /> S �/ TYPE DemollGon Sign riPE F New Gaa <br /> ( �� Sprinkler D�RepalrlMeinl. Olner <br /> GONTRACT PRICE OF WORK / . �1/� ._ CITY OF EVEIiETT I.00AL 9ALE9 TAl(CODE IS]103 <br /> � <br /> WORK DE9C0.1PTION �� ���Y ��4�`� ��/�,n � <br /> �Q CY <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIxTURE OR ITEM <br /> WATER CLOSET(TOILET) AIC—AlHAN CL W�UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCN[N SINIC d DISPOSAL CLO"fHES DRYER <br /> DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAV � WATER HEATER <br /> CIOTHES WASMER METAL FIREPIACElSTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGF <br /> �ACKFLOW PREVENTER _ GAS PIPiNG <br /> SINK(SERVICF/B�R/MOP/ETC.) _ EXHA�S?F4t+ � <br /> OTHER OtHER` <br /> — --— I <br /> I MEiiEBV CERITIFY THAT I HAVF READ ANO EXAMINED THIS APPUCATION AND KNOW TNE SAME TO BE TNUE ANL CORRECT A�L <br /> PHOVISIONS O�LAWS I1ND ORIDINACES GOVERNING TMIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECiFIEO HEAEIN OR <br /> NOT THE GRANTING UF A PERMIT UOES NOT PRESUME TO GIVE AUiNORITY TO VIOLATE OR CANCEL THE PROVISiON OF ANY CTHER <br /> STATE OR IOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OP CONSTRUCTION THAT I AM AUTHORIZED BY THE <br /> OWNER O�THIS PROPERTV TO PEPFORM 7HE WORK FOR WHICH APPLICATION�S AIAOE AND I COAIPLY WI'4 THE STATE <br /> CON�LA .27 RCW AND 296.2U0�. 1 �,/ <br /> �/1(lMc. / �� �^f� I <br /> Si at re of Owner�ConUactorlA i nzed Agent Date � <br /> DEBIT 8 CREDIT CARDS AR[ NOT ACCEPTED � <br />