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P�RMIT �4PPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.A PERMiT« <br /> 4l Co Ib 4�)by z: o00 000 ��l - O� <br /> LEGA LOT N0. BLOCK TRAC7 e <br /> DESC. -3 S 11 � {{"� �'i�M�R � 1� <br /> OWNER ^�/ /�_�/�v ADDRESS ZIP PHONE <br /> I � 1.P IJF <br /> S�r.. �na� J i� Co�b �y a y1s- aS - �.Li�- <br /> TENANT NAME ' I�C n � I C NTACT NAME PHONE <br /> s4r"'v ('c..l .S� I%t yyf - 1J3^>3Jl <br /> CONTRACTOR s'J,�� n��,5 �M� ADDRESS ZIP CONTR.LICENSE N <br /> �D 7f � t'/ J Nr�i �1Rr �" <br /> PMONE S V V T E OT �S 31� <br /> yL� _ 3f� , y3�� Sva.r.� H 5gzo3 <br /> PROOPOSEDC�OFBUILDING pERM1T I-{ Sprnkle�tion � Plumting ' WORK � Repaliri/Mein�, HEATSE�C�E <br /> T? �] <br /> TYPE �_{ Demolition Slgn TYPE New u Gas <br /> U U Olher <br /> CONTRACT PHICE OF WORK 5' e J � CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> WORKDESCRIPTION 't�,Nq+�t' jm�aMy1.M�+'1tS <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF flXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLINIi UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ CIOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TPAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVECE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND OFIDINACES GOVERNING THIS 1YPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREiN OH <br /> NOT. TH[GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL ThE PROVI510N OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING COfJSTFUCTION OR THE PcRFORMANCE OF CONSTRUCTION. iHAT I AM AUTHORI2ED BV THE <br /> OWNER OF THIS PROPERIY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CON7RA7TOF5 LAW 18.27 RCW AND 296.200 WAC. <br /> Signature oi OwnedCor.IractoriAuthonzed Agent Date t �Z <br />