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fi <br /> PE'tiMIT APPLICATI� <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAN STRE�T. EVERETT, WA 98201 i <br /> 425457-8810 — FAX 425•257-8857 <br /> I g—I 3-07 <br /> SITE AD�RESS PARCEL TAX I.D. N P�RMiT� _ 1 <br /> 1� L( <br /> U <br /> LEGA LOT NO. BLOCK TflACT <br /> DESC. <br /> OWNER AD�RESS ZIP PhONE I <br /> � <br /> I IiRti Ll�*k+Q� f�i�i�'n[�/i4'u�� <br /> TENANTNA I CONTACTNAME PHONE <br /> '�icrJ S�i��1 (Ua.S) 3�'�'- P12`� � <br /> CONTRACTOfl �U,� rL1.tS�tt�J.n{ ADORESSf� �3�-X IIID CONTR.LICENSEM i <br /> �tf:c,w �L',lf.l���F;OZN03 <br /> P�oNE ' �. ����,��-a qsz,Z I <br /> (v�,S�388- G'!�'f <br /> PROPO�ED USE OF BUILD�G �Bwlding r'1 Mechanical I Q�Addiiion HEAT SOURCE <br /> ('}(���,' U;�,7wrec7.d � t�� I PERMIT Combinalion K Plumbmg WORI. y/ A�Ie�a!�on � Eiectnc � <br /> d TYPE Demolilion L1 Sign TYPE � New Gas <br /> Sprinkler aepair t.ta�m. Other <br /> CONTRACT PRICE OF W09K �j''7 C� � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION G?'�IMI 'U.t Cry1;L'� .�'�' � 1^'�'�'�" {�['L� �"�*� ��'� �'"k ��''� <br /> �U I.�(?G�5 1� ��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO, TYPE OF FI%TURE OR ITEIN <br /> WATER CLOSET _ 1VC-AiHANDUNG UNIT;i <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCH[N SINK R DISPOSAL CLOTHES CRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY WATEF HEATER <br /> CLOTHES WASHER METAL FIFEPLACE/STOVE i <br /> URINAL _ FIREPLACE INSERT I <br /> DRINKING FOUNTAIN _ GAS FiREPLACE <br /> FLOOR DRAIN __ GAS RANGE � <br /> BACKFI.OW PREVENTER _ GAS PIPING <br /> SINK(SERVICEBARlMOP/ETCJ _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE aEAD AND EYAMINED THIS APPUCATICN AND KNOW THE SPh1E TO BE TRUE AND CORFECT. ALL I <br /> PROVISIONS OF V+WS AND ORIDINACFS GOVERNING THIS NPE OF WORK WIIL BE CO�dPLIED WI?H WHETHEF SPEGFIED HEPEIN OA I <br /> NOT THE GPANTING CF A PERfd1T�OES NOT PRESUMC TO GIVE AUTHOPITY TO VIOLATE OR CANCEL THE PROVISION OF 4NV OTHER <br /> STATE OR LOCAL LAW REGUWTING CONSTRUCTION GA THE PERFORMANCE OF CONSTPUCTION. THAT I AM AUTHORI�ED 9Y THE �, <br /> OWNER OF TtiIS PFOPERTY TO PERFORh1 THE WORK FCR WHICH APPLICATION IS MAOE AND I COh1PLV WITH THE STATc i <br /> CONTRACTOFS LAW 1827 RCW AND 296200 WAC. � <br /> ignafure ol OumenContractoriAuthonzec7 Agern Dale /Z <br />