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_- - ---- - -- � --- - ----- ----- <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C[DAR STREET, EVERETT, WA 98201 <br /> � <br /> 425-257-SE310 - FA� C25-257-8857 <br /> (! (�^ <br /> SITE ADDFiESS �G� � C'L 3Y O PARCEL TAR IA.# PER/7 a <br /> 04 3�0- vz o 300 7�7- / <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. N '/Z [at 3�+ V <br /> , «- 3 42j C e2t�7' o�v 3 <br /> OWNER AD�RESS ZIP PIIUNE <br /> F_il f V r.'Rft GL5o••1 �ol(,z �u�Ec. '�2 F�e2� a 2,,2c� 4�S- �,� 9.�i Z <br /> � <br /> l�NANT NAME CONTACT NAME PI10NE <br /> F_� f V e�.� G�Sv�v I f-n 6�SoN �2s Soa q�SZ <br /> CnOiJTRACTOR ADURESS ZIP CONTR.LICENSE N <br /> /�,dL11=iC UAe��es �^�C Z72b I�UCL'EI� �uL r�l[-rLTJ' G�`(�7C>) <br /> PI10NC- <br /> �ZS 2S�i-i3 �/ P.aci�b-� a4�r,�N <br /> PROPOSED USE OF BUILO�NG I fl Dtl�Wing hanical I Addilion I HEAT S9yHCE <br /> C�4paC•� S / ,30/� PERMIT K ComLinalion lumbing WORK ra�ion ��Electnc <br /> TYPE (� Oemolition Sign TYPE Nvw �� Gas <br /> �Q��-TMa�t,i L� Sprinkler Rep�iUMainl. U Othr�r <br /> CONTRACT PRICE OF WOFK C�D bD� 0(� /�A✓J/,�"�" CITV CF E1'ERETT LOCAL SALES TAX CODE IS 3105 <br /> 7) / �! <br /> WORK DESCRIPiION � � <br /> �UA�STih:CT ��L�.,� C�4QAGG �C4�J�J�.- I,�.i7>I D.ti�S �6b20o/`i U.ti�TiQ9U.�Cz 6A��7-G�^ <br /> II <br /> � PLUMBING MECHANICAI <br /> ND. TYPE OF FIXTUPE OR ITEM NO. TYPE OF fIXTURE OR ITEM <br /> 1_ WATEH CLOS6T NC-AiHl:NDLING UNITS <br /> . I 6ATHTU� FORC[D AIR SYSTEMS <br /> _7 �AVATOHY(WASIi �ASIN) H6AT FUMP <br /> SIIOWER � UNIT H[AT[RS <br />� 1 KITCHEN SINK 8 DISPOSAL � CLOTHES DRYEN <br /> _L DISH`NASHER _L RANGE HO00 <br /> � LAUNDRYTf�Af' _L WATERHEATER � <br /> 1 CLOTHES WASHER METAL FIREPLACUSTOVE <br /> URINAL FIR[PLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOH DRAIN GAS RANGE <br /> f3ACICfLOW PRGVENT[R GAS PIPING <br /> _ SINK(S[RVIC[/L3ARlMOP/[TC.) �� E;(�IAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE fiEAD AND EXAA7INED THIS APPLICATION AND KNOW TH[SAME TO OE TRUE A�JD COIiRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WOPK WILI�E GOMPUE�N9TH WI IETHER SPEGFIED H[REIN OR <br /> NOT. THE Gf7A1JTING OF A P[RA91T OOES NOT PRESUME 7D GNE AUTHORI7Y TO VIOLATE OR CP.NCEL THE Pt70VISION Of-ANY OTHER <br /> IS7ATE OR LOCAL l�W RFGUUU"ING CONSTRUCTION OA THE PERFORMANCE OF CONSTqUCTION. TI1AT I AM AUTHOR12ED l3Y lHE <br /> OWNER OF TI1�5 PROPERTV TO P[RFORM THE WORK FOR WHICH APPLICATION IS IdADE AND I GOMPLY WITN THE STATE <br /> I CONTRACTO S L W 173.D RCW AND 29G.200 WAC. <br /> �����'ti �7�(� � 7 <br /> Signalure ol Owner/Coniraclor�Au�hodzed��ent Dple <br /> `� v <br />