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P��i�MIT APPLICATIO�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8610 <br /> U���� <br /> SITE 4DDRESS �� �N PARCEL TAX I.D.A PERMIT# Bl-LY� <br /> - �'c.�ef l� y <br /> LEGAL LOT O. BLOCK TRACT <br /> DESC. <br /> OWNER ( ADDRESS PHONE <br /> -�'�e��e��c.� c4�s� <br /> P�(Y1G�Tb �ARTvJ��DS i �51a0 - 1�10� (kJE IUfc��Oci , �7�-1�7 - 1�77-Cv <br /> TENANT NAME CONTACT NAME PHONE <br /> vlCTo ,Neasn��lCe,iQrf� -PA�,� Cvaa�kl ��1�5� (n43-3£s3a <br /> CONTRACTOR ApDRESS CONTR. LICENSEM <br /> -TRS-STArE 1�tium6lN��r�, 13�I:zo nl� i�o� 5F • a.ssrr��ysN� <br /> PHONEC�a� �- $e11eJu.e U:Q �CY� <br /> PROPOSED USE OF BUILDING Building � Mechanical nddition HEAT SOURCE <br /> PERMIT B Combination Plumbing WORK � alterat�on D Electric <br /> TYPE D Demolition Sign TYPE New L] Gas <br /> U SprinRler Repair/Maint. U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION —T�e ��}p eXlS��r�q �a5�� C��?.� <br /> pLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF flXTURE OR ITEM <br /> _,,�, WATER CLOSET _ AIC-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> �?� LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN �lNK&DISPOSAI CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> CLOTHE3 WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> � DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _� FLOOR DRAIN _ GAS RANGE <br /> BACKFLUW PREVEN"CER GAS PIPING <br /> SINK(S[RVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L4WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED 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 AUTHORIZED BY THE <br /> OWNER OF THIS PROFERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTFiACTORS LAW 18.27 RCW AND 296200 WAC. <br /> 81ER���A/ll/dl _ ��j2�����//tifrV/ .� ��/ <br /> Sign e of Owned tractor uthonzed Agent Dete <br />