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- <br /> �- PERMIT APPLICATION -j <br /> CITY OF EVERETT PERMIT SERVICES i <br /> 37_00 CEDAR STREET, EVERETT, WA 98201 <br /> I425-257-8810-FAX 425-257-8557 I <br /> ' �J�G'�C {� �o �G�U �l' � /�As rc �12Y� i <br /> SITE ADDRESS �� PARCEL TAX I.D.# PERMIT# <br /> � �(1 3y35oo>��oovv� (�3C�9C� <br /> LEGAL LOT NO. BLOCK TRACT <br /> DCJC. � U S 13F.L��/2 L/ ���I/c�� I <br /> IOWNER ADGRESS ZIP PHONE <br /> � �i�JJ�i%� Srs�Ii��i S7/� CGL�1 � ClBi-U3 NLS"1�Jr'�/7/� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �t/�/a I 5 /7/�E /rs Uc�.u�•<' <i13- Z<S-`/��� I <br /> � <br /> COMTRACTOR ) , ADORESS LIP CONTR.LICENSE r � <br /> il� �� coti�TitUCrld•J � <br /> 5���� RP/zc�,cc97Uv/� i <br /> PHONE i��.�� <br /> PROPOSED USE OF BUILDING n�-y 6�iiJiny n Mut:lieniwi n Audition I MEAT SOURCE <br /> � � � I PERMIT ,�( Combination �} Plumbing IWORe: � Aiteration I � Electnc <br /> 7YPE (_J Demolition D Sign TYPE New Gas <br /> ��prinY,ler � P.coair;A!air,t C;hcr <br /> CONTRACT PRICE OF WORK ,('�G U��U .PO CITY OF EVERETT LOCAL SALES TAX CODE I�3105 <br /> /0 <br /> WORK DESCRIPTION <br /> GG.v:7/;u� j .u�c�J SI.U6tE f/)/�SLY RL•='OG�;�[= <br /> I I <br /> I <br /> PLUMBING MECHANICAL <br /> INO. IYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> I _j_ WATFR CI.OSET A�C-A!HANDLING I INITS <br /> 1_ BATHTUB � FORCED AIR SYSTEMS <br /> �' L.AVATORY(WASH BASIN) _ HEAT PUA1P � <br /> SHuYVeR UNI'i HENTERS <br /> � KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> UISHWASHER � f2AN(UtHOUD <br /> I / IAUNDRY TRAY / WATER HEATER <br /> i CI OTHFS WASHFR ''" •� I <br /> � + URINAL FiFEPLACE CJSERT <br /> DRINKING FOUNTAIN � GAS FIREPLACE <br /> � _/ FLOOR DRAIN / _. GAS Rr1NGE i <br /> BACKFLON'PREVENTER _( GAS PIPING <br /> SINK(SERVICE/OAR/MOP/ETC.) � EXHAUST FAN � <br /> — OT'-'EP, --- �T�'�R I <br /> I — r �� — � <br /> � -- �'� � , � �� � � <br /> II HEREBY CERITIFY THAT I HAVE READ AND EXAMINED T41S APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L1WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN nR <br /> in;nr. TFiF�neni7i�ir pc p oFaM1+1T�^E3 NOT?P.ESU.^.�E TO GIVE.4UTunnITYTO VI^L4TE OR CP.NCEL TNE PP.Q:9S!OM^F P.NY^TNFR <br /> STAT[OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOR2ED BY THE <br /> OWNER O PROPFRTV TO PFRFORM THE WORK FOR WHICH APPUCAT.ION IS MADE AND I COMPLV WITH THE STATE <br /> ! cor�- c�o ua:^,�^^�:�a � e.^co::��c. <br /> � � �� ,l �- i,� -v � <br /> ISign uro o(Owi lContracbrlAuthorized Agenl Dale <br /> �E91T& GREDIT CARQS ARE NOT A�GEPTED <br /> � <br /> L�70�-C7C��> i C) <br />