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i <br /> PERMIT APPLfCATION <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 TAX I.D.N PERMIT N <br /> Z� o� ro 9753 2 o i o o� /09-�Zg <br /> LEGAL LOT NO. BLOCK TFACT <br /> DESC. <br /> OWNER mGri np-G��O ADDRESS PHONE <br /> �4i��w �ae��c��� _ 14ZI Co� af � , ZS�- ��l(o <br /> TENANTNAME CONTACTNAME PHONE <br /> �r�^+� I �+M+�- s+�-,� �- <br /> CONTRACTOR ADDRESS CONTR.LICENSEIF <br /> ��ST ���cE �oor�a(� <br /> PNONE 221ti �o\s� 5Z �7• ��.3 5 2 <br /> PROPOSED USE OF BUILOIN6 � Building n Mechanical Additbn HEAT SOURCE <br /> PERMIT Combination I"� Plumbing WORK ueretwn eiectdc <br /> TYPE Demolilion � Sign TYPE New � Gas <br /> Sprinkler FepeldMeint. Other <br /> CONTRACT PRICE OF WORK IZV+-)� CITY OF EVERETT LOCAL SALES TAX CODE IS 3f05 <br /> WORM.DESCRIPTION <br /> �� ���0 t= <br /> PLUMBING MECMANIC�L <br /> NO. TYPE OF fl%TURE OR ITEM N0. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET ,_ NC—A/HANDLING UNITS <br /> BATHTUB _ ��ORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ hEAT PUMP <br /> SHOWER _ I;NIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ �LOTHES DRYER <br /> DISHWASHER _ I�ANGE HOOD <br /> LAUNURY TRAY _ WATER HEATEH <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSFRT <br /> DRINKING FOUNTAIN _ GAS FIREPLACF_ <br /> FLOOR DRAIN _ GAS FANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREOY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLI[D WITH WHETHEP SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATC-OR LOCAL LAW H[GULATING CONSTRUCTION OR THE PERPORMANCE OF CONSTHUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERIY TO PERFOPM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT TORS LAW 18 RCW D 296.200 WAC. <br /> Iul� ��i�� g'Z��� <br /> S�i nalure ol Ow Coniractor/Authonzed Agent Oale <br /> r <br />