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�_ <br /> P �MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3?00 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> SITE ADDRESS PARCEL TAX I.D.# �� ` �""�' PERMIT# <br /> S3Zl E7/c��Qc�� W 5���� ' � <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS PHOME <br /> R�s� �i�oPta.;,� s � ii�yZ �y��'.r,. ���E„v�, �,�.� �s �.�6�ir <br /> TENANTNAME i CONTACTNAME PHONE <br /> 1=000 1�f3vtUo� � FZ�,.�IL 4z�s, 33�•y��� <br /> CUNTRACT'JR ADDRESS CONTR.LICENSE# <br /> PHO E�r ' SI b!� �IG�S ��0'�-11 I���L W ' ! St' BaTsr��`9���� <br /> ��}25) 33og/bo MtL�CZ�"� � ln/4'} `��'0�2 —03 <br /> PROPOSEO USE OF BUILDING Building �Mechanical Addition HEAT SOURCE <br /> / PERMIT Combination Plumbirg WOFK Altera�ion RElectric <br /> ��(ZOCCp.��/��0 �� TYPE � Demolilion Sign TYPE New �] Gas <br /> � U Sprinkler RepaidMainr. U Other <br /> CONTRACT PRICE OF WORK Jp �p00,� CITY OF EVEREfT LOCAL SALES TAX CODE IS 3105 <br /> YlORKDESCRIPTION '�S�L ��� 5���� �'�� 3��r X IO � .)GL�/Mli✓/i'�7j <br /> S/6�� 0/�1 M�L C�2 f D. A1 l� ! EX�S'f rr!G: Sl I�iJ �1c"'�L- �-� S p,°�,c <br /> wrc.t� g� ,�(-'�-r> 8 'i�N� -TD t3� • <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> IAVATORY(WASH BASIN) _ HEAT PUMP � <br /> SHOWER _ UNIT HEATERS <br /> = KITCHEN SINK&DISPOSAL � _ CLOTHES DRYE�� � <br /> — DISHUVASHER � _ RANGE HOOD / <br /> IAUNDRY TRAY _ WATER HEAT�fR <br /> CLOTHES WAS ER _ METALFIREPLAC TOVE <br /> URINAL _ FIREPLACE IN <br /> _ DFINKING FOUtyT N _ GAS FIF!EP , E <br /> FLOOR DRAJAY _ GAS RANGE � <br /> j BACKFLOy�/PREVEN�ER _ GAS PIPING <br /> SINK(SERVICE/BAR/tdOP/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 ORIDINACES 30VERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEP <br /> STATE OR LOCAL LAIN REGUL4TING CONSTfiUCTION OR THF PERFORMANCE OF CO�STRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTfiACTOR W 78.27 RCW AND 296100 WAC. <br /> • / i� � / q <br /> Signai of OwnedCoMractor/Authonzed Agent D te nv�� <br /> L' <br />