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P`CRMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVIGES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> p- M,u�3 -0 3�! <br /> SITE ADDRESS 9p�� PARCEL TAX I.D.N • <br /> PERMIT N <br /> = G�39 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. � <br /> OWNER ADDRESS ZIP PMONE y1S <br /> �cm.a/�(�. Th�+» ��ivo Ei-..;5,�rrnc�� Ft/e.u�� Gurl <br /> ni rt� '`'="'. �.q • �Fr�o3 35s-o�a �' <br /> [��r�n ,.�.n� r d 7 0 <br /> 7ervAN7 NAME �•�,I6�Hr�/A/ CONTACT NAME PHONE <br /> f'I9�:Ai� E/'E/,nPl�/m.��.�,a.f I (y1 s) '�s�3 a3b 3 <br /> CONTRACTOR ff y L �pi�,.5{ruc f+�»2 ADDRESS LP CONTR.UCENSE N <br /> /Sao c<,. �c.a.:�c r4�'c( �-F 2n8 L`n,Vs"•cu+x o <br /> aHONr�Yu�3vS- 3�ic. Ev{.�.�,t/, �u.9 �'S�-uy <br /> PROPOSED USE OF BUILDING n Building p(t�qechanical Adtlition NEAT SOURCE <br /> PERMIT �_� Combinalion H Piumbing WORK R Alleratlon I � Eiectric <br /> TYPE �__� Domolition V Sign TYPE D New Gas <br /> Ll Sprinkler U RepaidMaint. Olher <br /> CONTRACT PRICE OF WOpK j 3�•�J d CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKOESCRIPTION �:✓�tJtc�ft.��ez�l+f7'n.. c�,' ea-S!/�JC4� .� Ct C Mfe r. /r�fc r<...a! 6.J n.<lc(ii1�1 <br /> Ri�.a'✓Ir4crSlr'��:"L'�fqi7�,�F�.:����5 .���ui�c.lf �r.a 'sfi.� %rcccl. , � ✓ <br /> 1C� 5 //���, G�ltL:tl y�Z� /� <br /> ✓ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FlXTURE OR ITEM <br /> _ WATER CLOSET _ A/C-A/HANDLING UNITS <br /> _ OATHTUB ' _ FOFCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) T _ HEAT PUMP <br /> _ SHQWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER ANGE HOOD <br /> _ LAUNDiiY TRAY . � WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACF./STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DFINKING FOUNTA�N ' _ GAS FIREPIACE <br /> _ FLOOR DRAW GAS RANGE <br /> _ BACKFLOW PREVENTER � GAS PIPING <br /> _ SINK(SERVICE/BAR/MOPlETC.) _ EXHAUST FAN <br /> _ OTHER � OTHER <br /> .I HEREBY CERI7IFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WIiETHER SPECIFIED HEFEIN OR <br /> NOT. THE GFANTING OF A PEFiMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> 57ATE OR LOCAI LAW REGU TING CONSTRUCTION OP THE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERN , PERFORM THE WORK EbR WHICH APPL�CATION IS MADE AND I COMPLY WITH THE STATE <br /> CON7RACT RS LAW 18.27 F�CW AND 296200 WAG! <br /> .t y �/`�_ -� � 3�.,���02 <br /> Signature o(O ner/ � t1Au1 orized Agent Date <br /> � <br />