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P�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> 3 <br /> SITE ADDRESS PARCEL 7AX I.D.N PERMI7 N <br /> 3 � 0 � �oib AVE o <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS � PHONE <br /> _ [vv< �l (a�US�w, (�a�+.�.:,� I � 1C�7 �o �b A✓c 4�s - )o3 -�io3 <br /> TENANTNAME � GONTACTNAME <br /> CVQ�(11 '�OtiS;h Ak�l.a�,} PHONE <br /> � � ae�. ��s- 3o3 -tio.3 <br /> CONTRAC70R A�y�Io„�, YY►c[.i,.,,1/r� ADDpESS CONTR.LICENSEN <br /> PHONE ( L{? 5� �1 G,-q $ rJ 7 I f�F�' ✓�JoX Gv 56 � L��,.pr,�/ <br /> � w GK 36 I <br /> � / 0 z.Z i O �'ve �-{ <br /> PROPOSED USE OF BUILDING Building �Mechanica� ddition HEA7 SOURCE <br /> p f(,c�_ PERMIT B Combination Plumbing WORK �quereuon [� Electric <br /> TYPE D Demalition SiB� TYPE D New u Gas <br /> U Spdnkler U Repair/Meint. L� pther <br /> CONTRACT PRICE OF WORK S O� CITY OF EVEREIT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> Q'm^ �i\f.�q�«dt> 1 �� G�r ��F�uS�.S 1 v1D morc -�� Ic� -!Z ,Fo�a I � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM N0. TYPE OF FlXTUpE OH ITEM <br /> _ WATER CLOSET _ A/C-AlHANDLING UNITS <br /> _ BATHTUB � FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMF <br /> _ SHOWER _ UNITHEATEP,S <br /> _ KI7CHEN SINK 8 DISPOSAL _ C�OTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ UIUNDRY TRAY _ WATER HEATER <br /> _ CLOTHES WASHEfl _ METALfIAEPLACFJSTOVE <br /> _ UR�NAL _ FIREPLACE INSERT <br /> _ DRMK'�G FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOPlETC.) ,_ EXHAUST FAN <br /> OTHER <br /> — _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAtA1NED THIS APPLICATION l.ND K�YOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERIVING THIS T'PE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NUT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CAiJCEL THE PROVISION OF ANV OiFIER <br /> STATE OR LOCA�LAW REGULATING CONSTAUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUiHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC7�RS LAW 1827 R�, A D 29G200 WAC. <br /> � � !� <br /> 'Z2 0 <br /> S ture ol onqaclo uthorized Agent Date <br /> � <br />