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I � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8870- FAX 425-257-8857 <br /> SITE ADJ��S� PARCEI TAX 1.0.11 PERMR• <br /> � �o�� r .P- ur_ I �V��—�� <br /> 5� Oi o /.7 >� .✓�- /fif ^ 57�e�v <br /> LEGA l0T NO. SLOCK TRACT <br /> DESC. <br /> OWNEA ADORE59 LP PMONE <br /> V!'.✓.r%+ r/.+i� so��v z9�l-v- cr'�/l1' � viL rvis�•..=tr %Paor _ <br /> TENANTNAME � CONTACTNAME PHONE <br /> `f>-s -� s8'- F �G G <br /> F/lFi�F Yr TH��o-y.z�- S�•�T L�i- N�4 /�✓i� s ��s- 3 !F - sssr s � <br /> CONTRACTOR A�DRESS ZIP CONTR.LJCENSE� <br /> PHONE <br /> PROPOSED USE OF BUILDING �Building n MeChanical Atldition MEAT SOUHCE <br /> � PERMIT !"'�1 Combination �-� Plumbing WORK R Alterotion � Electric <br /> � TYPE f_� Demolilion V Sign TYPE D New Gas <br /> L/ Sprinkler I U Repair/Maint. Other <br /> CONTFiACT pRICE OP WORK 7Q� �" CITY OF EVEAETT LOCAL SALES TAX COCE IS�105 <br /> / � <br /> WORKDESCRIPTION v_S�p� G.���,�, 7- � <br /> �NfT.a-c ffif-M/� /t�/S�/� /�"N/1 /� <br /> /l�f��.+-ciS /JOf/�' �../c�(- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM N0. TYPE OF FlXTURE CR ITEM <br /> WATER CLOSET A/C-A/FiANDLiNG UVITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 OISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDFY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPI.ACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/DAR/MOP/ETC.) _ [XHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERtTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE FiAME TO BE TRUE APlD CORRECT. ALL <br /> PROVISIO�S OF lAWS AtJD OR�DINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIIJ OR <br /> NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROViSION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHONIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOP WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOPS LAW 18.27 RCW AND 296.200 WAC. <br /> � r . � <br /> �---�--���> � " / �� eZ <br /> /._ y�___, ._ ._- -^- /:,�� _ � — <br /> Signalure ol Owner/ComractodAuthonzed gent De��+ � <br /> 1�2 I <br />