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P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> SITE ADDiiESS PARCEL TAX I.D.t PERIAIT M <br /> � 131 C=y sTNvT Z�lUS1o�1�3oe �Puitr/oro('� �L.' �f7(� <br /> LEGAL LOTNO. BLOCK TRACT ��LJCf L- S�yoRf 5 �80/✓�,f/�.►��t-�e--�1�j- <br /> DESC. ��. % n � _ <br /> OWNER ADORESS PHONE <br /> ��l�l'�['F' H� NA �GF/ I 1 I 3 1 I•I�Cy f�M /1 tyt I �/ Lf ts t 7 S�SO <br /> TENANT NAME CONTACT NAME PHONE <br /> I L/9iQ/l Y /✓iA�/S�!�ry I y�S �S� 7 Y.So <br /> CONTRACTOR ADDRESS CONTR.LICENSEN <br /> r/�r t-/,A�[.ors i ( z r g�Ni A� y,be ,r.E' <br /> PHONE � �f �r� � y ,.o r'A��� y3o�h <br /> PROPOSED USE OF BUILDIN6 Building n Mechanical Aadiuon HEAT SOURCE <br /> PERMIT Combinatian �"S Plumbing WORK Bniterauon Eiectric <br /> SIlJ(�L.E FAMi�Y Q�,Sin, T'rPE Demolitlon D Sign TVPE �"New �Ges <br /> Sprinkler U Rapair/Meint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERE7T LOCAL SALES TA7t CODE IS 3105 <br /> WORKDESCRIPTION 12,?j6 S,F, �-�OvSE <br /> ,� /l� � / /'���(�.`C- <br /> �LUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM N0. TYPE OF FlXTUF�E OR ITEM <br /> WATER CLOSET A/C-l4HANDLING UNITS <br /> � BATHTUB T FORCED AIR SYSTEMS <br /> '✓ UIVATORY(WASH BASIN) _ HEAT PUMP <br /> �— SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL I CLOTHES DRYER <br /> T DISHWASHER � RANGE HO00 <br /> LAUNDRY TRAY � WATEA HEATER <br /> L CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GP.S FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PFEVENiER GAS P�PING <br /> SINK(SERVICEidAR/MOP/ETC.) EXHAUST FAN <br /> OTHER _ OTHER �/ <br /> — `/ — <br /> I HEREBY CERITIFV TI1AT I HAVE FEAD AND EXAMINED THIS APPLICATION AND KNOW THE S4ME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF U1WS AND ORIDINACES GOVERNING THIS TYPE OF WOPK WILL BE COMPLIED WITH WHETHER SPECIFIEU HERE�N OR <br /> NOT THE GRANTING OF A PER611T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br />' STATE OR LOCAL LAW REGUL4TING CONSTHUCTION OR THE PEfiFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> GWNER UF THIS PROPF.RN TO PEAFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV WITM THE STAiE <br /> CONTRACTORS LAW 1837 FCW AND 296.�00 WAC. <br /> .��-�-.,f-������C 6 � 5 -u 3 <br /> Sig ature ol Owner/Conl actodAuthonzed Agent Date 1/ <br />