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P(�RMIT APPLICATi��.� <br /> CITY OF EVERETT PERMIT SERVICES �C re�F : <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �'�" L�9���O�D <br /> 425-257-8810- FAX 425-257-8857 �" � <br /> SITE ADDRC-SS PARCEL TAX I.D.k PERMI7 x <br /> �aus �2, �a A.,� 6zD �a� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS Z�P PHONE <br /> Ro��c'� � k�'�-, ��w.c�� I 3o o � G s� A>a SL- S,.�l.,.,,..;s k J�ye l.�n �t Y i� 6 <br /> TENANTNAME I CONTACTNAME PHONE <br /> �o , �,-� o�,ti,�c�,, �yasl 316- ti167 <br /> CONTRACTOq ADDRESS ZIP CONTR.UCENSEM <br /> PHONE <br /> PROPOSEO USE OF BUILDING BUflding � MechaniCal Addilion HEAT SOURCE <br /> PERMIT B Combination Plumbing WORK � Alteralion � Eiectric <br /> TYPE D Demolition Sign TYPE New Gas <br /> U Sprinkler RepaiuMaini. Olher <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORKDESCRIPTION %�/f�l�e � M, Mp♦ ,� ���n�� nli�yf�Z��TCh� <br /> (��/ ���.�.�.�� , �r. x_��v <br /> I PIUMBING MECHANICAL <br /> I NO. TYPE OF FlXTURE OR REM NO. TYPE OF FIXTURE QR REM <br /> ! WATERCLOSET _ A/C—A/HANDLINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> i _ LAVATORY (WASH BASIN) _ HEAT PUMP <br /> � _ SHOWER _ UNITHEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> , URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIFlEPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK (SERVICE/BAFUMOP/ETCJ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE REAL�AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AU�HOR�TY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL 1.4W REGULATING CONSTRUCTInN OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTFiORIZED BY THE <br /> OWNER OF THIS PROPgE,2RTY TO PERFORM THE WORK FOfl WHICH APPLICATION IS h1ADE AND I COMPLY WITH THE STATE <br /> CONTRAC 5--�l3— V CW 96200 ^C. I I <br /> q � 02 <br /> Signature of Owner/Contractor/ u onzed Agent ate <br />