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PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FHX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.M • PERMiT M <br /> .j n � a d ` -�v� D ?3700(val t��r203_a�t3 <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. ' <br /> OWNER AUORESS ZIP PHONE <br /> EU��c7T Na��i��ir �-lUr�ar �l�v �z�r�� (^olPr r- v=ier7r <br /> TENANTNAME CONTACTNAME PNONE <br /> ��cn��;- �����,�� �-��,-�,�,�� ,e�cn.���,� �1c�CD� 3U� ��z � <br /> CONTRACTOR —�— qDDRESS LP CONTR.LICENSEII <br /> vHon�OG�Q�SS(vL ,BU�.C />�-rc {733v 3�s✓ /)1� fU�-u 9P��? (�l('OGRB /o33J <br /> =��,� -c�s� - i oa� <br /> PROPO£ED USE OF BUIILDING � Bu+lding Mechanical f� Ad4iUun HEAT SOURCE <br /> PERMIT Combinalion R Plumbiny WORK ��� Allerellon � Electric <br /> TYPE Demolition � Sign 1YPE 4.1 New Gas <br /> Sprinkler LJ RepaidMeint Olher <br /> CONTRACT PRICE OF WORK � � �/ � CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> C� <br /> WORK DESCRIPTION <br /> ��{ 1C.� CCA1�1i'UC�70rV <br /> Ct,��-� G�EC.7'�IC�1� U�Cr/�i p �C S <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYFE OF flIfTURE OR ITEM <br /> _ WATERCLOSET _ NC–A/HANDLINGUNITS <br /> _ BATIiTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BAS�N) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ D�SI�WASHEli _ RANGE HOOD <br /> __ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STO��C-. <br /> _ UqINAL _ FIREPLACEINSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENT[R _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER_ _ OTN[R <br /> I HEflEBY CERITIFY iHAT I HAVE FEAD AND ExAMINED THIS AFPLICATION.1ND KNOW THE SAME TO BE TRUE AND CORRECT, ALL <br /> PROVISIONS OF LAt'dS AND ORIDINACES GOVERNIP7G THIS TYPE OF�.YORK WILL BE COIdPL1ED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTI�'�OF A PERMI7 DOES NOi PRESUME TO GIVE AUTHOFlIN TO VIO:ATE OP CANCEL THE PROVISION OF ANY 07HER <br /> STATE OR LOCAL lAW REGULAiING CONSTRUCTION OR THE PEFFOPMANCE OF COf.STRIICTION. THAT I AM�UTHORIZED BY THE <br /> OWNER OF THIS PROPERiY TO PERFORM THE WORK FOR WHiCH APPLICATION IS MAUE AN�I COMPLY WITH THE STATE <br /> COIJTRACiORS LAW 18.27 RCW D 296 200 WAC. <br /> i /' <br /> ..��2�f'� Q � [t_Q-cr -� -a2�-D .. � <br /> Signature of Cwner/Conlr ctor Authorized Agent Dale !I� <br />