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PCRMIT APPLICATI�N -� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425•257•8857 <br /> SITE ADDRESS / / /, PARCEL TAJ(I.D.N PERht1T M <br /> � /Y l � iva.. v55�3 - I -•a.i5-vv CG3�9•o/ <br /> LEGA �S `I Z G BLOCK TF�CT � � / <br /> �ESC. � j j I l�P U' tt, t d/lL <br /> OWNEH ADORESS ZIP PHONE i/L� <br /> ��1��- �,�,���, /s�� �'l�s>��!- �� 9�'�z as9� ��� <br /> TENANTNAME `� I CONTACTNAME PNONE <br /> a.�`�r � <br /> CONTRACT H ADDRESS � ZIP Cnu7R.LICENSE N <br /> �,�-F� (����� . /z yzs �'"'�,,'/£_ n,�. �. .. ;. <br /> �p - _ � C� �cr�jn 7�-,� 9b'.i 33 _`��.ON �IyI 1 �: <br /> PROPO:SED USE OF BUIL�ING I Building n MecheniCel Addilion MEAT SOURCE <br /> PERMIT Combination H Plumbing WORK Alleratlon R Electric <br /> TYPE � Demolition LJ Sign IYPE New �j Qea <br /> Sprinkler Repeir/Maint. U O�her <br /> CONTRACT PRICE OF WORK / 7��D — CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> / <br /> � WORK LcSCRIPTION <br /> IL�-/�'Il�.�. �l/� �l�Cp�Z./ Cd/,Jt�Gl2.� <br /> IPLUMBING MECHANICAL <br /> � NO. TVPE OF FI%TURE OR ITEM N0. TVPE OF F�XTURE OR ITEM <br /> i WATERCLOSET A/C-A/HANDLINGUNITS <br /> � BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> � SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DAYER <br /> DISHWASHER RANGE HOOD <br /> IAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIFEPL4CE/STOVE <br /> URINAL FIREPLACEINSEFT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANOE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICFJBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERI7IFY'HAT I HAVE READ ANG E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANG CORRECT. ALL <br /> PROVISIONS OF W WS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHEP 5'�ECIFIED HEREIN OR <br /> NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PFOViSION OF ANY OTHER <br /> STATE OF LOCAL LAW REGUUITING CONSTRUCTION OF THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 9Y THE <br /> OWNER OF THIS PROPERTY TO PERFOPM THE WORK FOR WHICH APPLICATION IS MAOE AN�I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1B 27 FCW AND 296200 WAC. <br /> I �//; 7 �. /� <br /> '��..-t•\ -�Lc a�'L�,�L-� 7�L 1�i <br /> Signalure of Ownev oNractor/Authorized AgeN alb e— IL <br />