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. <br /> i <br /> PERMIT APPLIC�►TION <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.M PERMIT q <br /> �� A GY�-�/OG4CD01 JGY� I Ro i (G.fly 2 <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER 4t. cC �L �elnd\ PQPiitSAD6RESS 7l d'�c�^ 10�1 quF Sr ZIP p NE 3-85']-jU70 � <br /> {erw.v��;y lteht 4ttoq°f <br /> �'FAJ ,()hUYEa1 T .lr'lSs�4y Q7� .cvE <c �v ��r- u�A �IKfbk <br /> TENANTNAME I CONTACTNAME PHONE <br /> _+dNC�FI �-IAtR (��li�'S <br /> CONTRACTOR AODRESS ZIP CONTR.LICENSE N <br /> ,GtCN�S /NG /Z 6z�J 7o�/dye. S p �9'�9 <br /> PHONE ��TTCC�� � �OI7S I��E/IIS� � <br /> 20�77z$33/ <br /> PROPOSED USE OF BUILDING Buildin� Mechunical Addition HEAT SOURCE <br /> 1 PERMIT Combination LR1 PlUmbing WOR Ilerali Electric <br /> {�L�� S O�,`G� TYPE Demolilion u Sign 7ypE�� �' <br /> Ges <br /> Sprinkler � qepaidMaint. Olher <br /> CONTRACT PRICE OF W6RK �'� ve- ��� /�a%�"Ll�Lii�'.S C�TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> ��y <br /> WORKDESCRIFTION Q�+'no'1/` t CLi'.�• �/L /,��Q'G✓S G1c.-S� ^ �{ <br /> 2 ��9 �/"�'�_ � <br /> PLUMeING MECHANICAL — <br /> 4 <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTUflE OR ITEM <br /> _ WATER CLOSET _ A/C-A/HP•`�DLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATEAS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATEfl HEATER <br />( _ CLOTHES WASHER _ METAL FIREPLACE/STOVE ' <br /> _ URINAL � FIREPLACE INSERT � <br /> _ D(iINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> ___ SINK(SERV�CE/BAR/MOP/ETC.j _ EXHAUST FAN � <br /> _ OTHER _ OTHER <br /> I — <br /> — — i <br /> I HERE�Y CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME 1'O BE TRUE AND CORRECT. ALl <br /> PROVISIONS OF U1WS AND ORIDINACES GOV[RNING THIS TYPE OF WORK WILL BE COMPLIED WITH WI1EfHER SPECIFIEO HEREIN OR <br /> NOT. THE GRANTING 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 AUTHOFIZEO BY THE <br /> OWNER OF THIS PROPERTY TO pERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW qND 296200 WqC. <br /> 9!///i.�' / .s�r i4 .9nDl <br /> SgnalurebF(3wn rrto'niracioqAulhodzedAgenl —-� Date / <br /> �/L <br />