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SITE ADDRESS <br />a 93 �, <br />LEQA LOT NO. <br />DESC. ��.f � 4 <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />BLOCK <br />PMCEL TAX I.D. � <br />3� <br />�� <br />PEAMiT M <br />�Q3G1_p ( I <br />NouE � <br />�/�. /� ADDREsa�,� � �'��' uC� � <br />CONTRACTOR ��L"V1J.�IJ �� II UCI �o� do3o �%� 51 SN% �J^'� aJ�, 480.:7 <br />PHONE y?S � .� SD � 0�.� <br />PNOPOSED USE OF BUILDIN6 <br />PERMR <br />TYPE <br />COMRACT PRICE OF WORK �" <br />Q <br />BBufWing D Nbchanical Addtticn f NFti7' ^_•OURC� <br />Combination j� Plumbing IWORit a A,Keratbn i r,� Elc�ric - <br />BDemolition U�fln T� l•,� NB`" :+� ^„' <br />Sprinkler (K o1 heeds) R� Rar�sU/�4ai�A _ ' .. . _ _ <br />CITf OF EVERE: T LOCAL Sf.�.E3 TRX COGE ... :: ;ta• <br />WORKDESCRIPTIONF,x �n,`„T.1^� �U�S ��Sia�� lU�'k� Fac�4A°v�as <br />New 5u1r.'�5 Z�s1411�d o�ouln SPou15 A^� S��aS� b�atliS <br />j'ebc.;ld FmnT aF yo,raw� cc�,evc �ol��� 1'lal�1'�al CeS,'dc Ial►�u1cH FY�SI <br />NO. I TYPE OF FlXTURE OR REM <br />WATER CLOSET (TOILET) <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PFEVENTER <br />SINK (SERVICEBAR/MOP/ETC.) <br />OTHER <br />NO. I TYPE OF RXTURE ON REM <br />A/C - AMANDLINO UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANCiE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RAN�E <br />GAS PIPINCi <br />EXHAUSTFAN <br />OTHER <br />1 HEREBY CERITIFY THAT I HAVE RFAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS iYPE OF WORK WILL BE COMPLIm WfTH NMETHEA SPECIflED HEHQN OR <br />S�ATE OR LOCAL LAW R GULATING CON TRUCTION OR THE ERFOTRMAN E OF OONSTIiUCT10N. THAT I AM A V'SUTf10� 8Y TME ER <br />OWNER OF THIS PROPEHTY TO PERFORM TME WORK FOR WHICH APPLICATION IS MADE AND I COt,1PLY WITH TME STATE <br />CONTRACTORSLAW1827RCWAND29 20WAC. r �O�L CPMPIfpn�� <br />�- /y� o -1 I7�, <br />Signature o Owner/ConlractodAutho ed genl e�e f(i L rq � <br />v V v�+ <br />