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�ER�i�IT APPLICAT�N <br /> CITY OF EVERETT ?ERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810- FA/. 425-257-8857 <br /> S�€ADDRE� PA{7CEL TAX I.D.# PERMIT a <br /> �-��o. � P� P� -�i��e .p � o h- o 0 <br /> IEGA LOTNO. LOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 <br /> ����hd �� 0 3��o �� �eu��, �o l�v�[ �I�l (�or-�P���C�qq�y3r <br /> TENANT NAh7E ����`�,� U� � CONTACT NAME PHONE <br /> �,'410 V� tC V1 d � I "��1. L 1 •l S, � i- �(7 � <br /> CONTRACT ADDRE � �— <br /> i /�v ( �� /�2 � \ C ZIP CONTR.LICENSE p <br /> PHON C. 1 � 5� 17l f( 4 5. IL r ���.µ �.U� ^ C <br /> � v� " �? <br /> L/� 13 <br /> � PROPOSED USE OF BUILDING BUilding Mechanical Adtlition HEAT SOURCE <br /> �I PERMI7 B Combinalion R Plumbing WORK B Allerolion � Electric <br /> TYPE D Demolilion p Sign IYPE D New Gas <br /> U Sprinkler U RepairRdaint. Other <br /> CONTRACT PRICE OF WORK a/100 0 �� CITY OF EVEREif LOCAL SALES TAX COOE IS 3105 <br /> Y�ORK DESCRIPTION <br /> �n �ivU� � C�vt ►1,t�rGc, �- �C��'cP� e �� l—�������x�a' � <br /> � - .�"- c �. C� i � �(� i� � S S �, <br /> iPLUMBING MECHANICAL <br /> NO. TYpE OF FlXTURE OR REM NO. TYPE OF flXTURE OR REM <br /> _ WATEF CLOSET _ A/C—A/FIANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> ' _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWEFi _ UNIT HEATERS <br /> _ KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER ! RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> i _ CLOTHES WASHER _ METAL FIflEPIACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SEFiVICE/BAWMOP/ETC.) � EXHAUST FAN <br /> _ OTHER � OTHER 11-f h aI✓ r-•rt� <br /> � I HEREBY CERITIFY'HAT I HAVE FEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOFITY TO VIOLATE OR CANCEL THE PROVISION OF P4Y OTHER <br /> STATE OR LOCAL LAW REGUUITING CONSTRUC710N OR THE PERFOPh1ANCE OF CONSTRUCTION. THAT I AM AUTHOFIZED BY THE <br /> OWNER OF THIS PROPEFTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY W;TH THE STATE <br /> CONTRACTOFS LAW 18.27 RCW AND 296.200 W C. <br /> � ' %� 2 G ��---- <br /> Signa�ure ol wn / ractor ulhoriZe Agen Dat <br /> % ��.2 <br />