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' � � .MIT APPLICATIO� <br /> CITY OF �VERETT PERMIT SERVICES , <br /> 3200 CE.�A.R STREET, EVERETT, WA 98201 I � � • ' <br /> 425-25'I'-8810- FAX 425-257-8857 L. d rT <br /> F�.�_ <br /> SITE ADDRESS A PERMIT# <br /> i q- � Cb393q-00S-6 9 - 1 <br /> LEGA LOT NO. BLOCK TRACT �Q <br /> DESC. 2, {} � E �f �Q,3 <br /> OWNER ��RE�X 3�'7CJ� 99zz3 PHONE <br /> LINDS�� GaNsr�vcr-�a� mc sPakA�� , ��iI�SH�,U�rn-� So9-�R-io/3 <br /> TENANT NAMF CONTACT FOR PERMIT PHONE <br /> � I ,�Dh/1 �(/r�!/S �z� 7Sz/-2Z 30 <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE N <br /> !_�Nvsey C'�oNsr,�vcT'in�✓ %vc <br /> PHONE 5'�-��E �S D�,vAIr.� ���DSG(D�O�pDc(/ <br /> PROP05ED USE OF BUILDING Building � Mechanical Additlon HEAT SOURCE <br /> PERMIT R Combinatlon Plumbing WORK � Alleratlon � Elecvic <br /> TYPE D Demolitlon Sign TYPE New Gas <br /> C� Sprinkler RepaldMaint. Ofher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCILL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> �u � l�J siN6�E s Nc� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXNRE OR ITEM NO. TYPE OF FD(TURE OR ITEM <br /> 3 WATER CLOSET(TOILET) A/C—A/HANDLING UNITS <br /> � BATHTUB �, FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> / SHOWER UNIT HEATERS <br /> � KITCHEN SINK&DISPOSAL 1,_ CIOTHES DRYER <br /> �, DISHWASHER � RANGE HOOD <br /> LAUNURYTRAY ,� WATERHEATER <br /> Z CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT' <br /> DRINKING FOUNTAIN � GAS FIREPLACE <br /> �_ FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER �- GAS PIPING <br /> SINK(SERVICE,'BAR/MOP/ETC. � EXHAUST FAh /� J <br /> � OTHER C�.I9 !7/J�G{l/�1 _ OTHER <br /> --'1r -/�/1Sf, /�� <br /> I HEREBY CERITIFY TFIAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIOINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING GF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING COhSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZEO BY TNE <br /> OWNER OF TFilS PZOPERTY TO PERFOFM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTO S LAW 8.27 CW l�ND.296.200 WAC. <br /> `1N.p �y, �1G4K� <br /> ��u��r�r,r;� � �� ��9-Zoo4 <br /> Signature of Owner ContractodAuthonzed Agent Date 1/Z <br /> L_ DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> ��14�' �E�7 Z�� <br />