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f�t <br /> �RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PEFiM17 M <br /> 4830 L2nw�nd �e, oo So a�44o1 CO26Ce-C�0 �O <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS ZIP PHONE <br /> ��c � `�ebanh � ,�iov� 483� alenw� �ve 9sao3 4as aSs - �4aa <br /> TENANTNAME CONTACT NAME PHONE <br /> �Jvc � `�eb�m(� 4,�1-b.� i'J�c 8.,t-tuh uas-asB-wJ-Q <br /> CONTRACTOR ADORESS ZIP CONTH.UCENSE N <br /> £� _iotir t�rdwe.(� I�-(��i 433�-d /wt S� 98as1 BaRDtWc,T o2-3PN <br /> PHONE �I��,r I <br /> i <br /> PROPOSED USE OF BUILDING f7 9uilding D MechaniCal Addition MEAT SOURCE I <br /> PERMIT �_� Combination �j PlUmbing WORK Alteration Electric <br /> �Q��p�l TYpE �l Demolilion U Sign IYPE New �Gas <br /> U Sprinkier RepaiUMaint. Other <br /> CONTRACT PRICE OF WORK �� �� � S�7 CITY OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> WORK DESCRIPTION <br /> {k u�cdc�,� , C�L� '�. ,be�Yoams , � bc�IG� <br /> PLUMBING MECHANICAL <br /> ryp, TYPE OF FIXTURE OR REM NO. TYPE OF FIXTURE OR ITEM <br /> I WATER CLOSET A/C—A/HANDLING UNITS <br /> I I BATHTUB _ FORCED AIR SYSTEMS <br /> � �_ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> � KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> ' DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> i _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> ' DRINKING FOUNTAIN _L GAS FIREPLACE <br /> FLOOR DRAIN � GAS RANGE <br /> I BACKFLOW PREVENTER 2 GAS PIPING <br /> SINK (SERVICE/BAFVMOP/ETC.) �_ EXHAUST FAN <br /> OTHEF . � OTHER � S�f <br /> — _ �Rs�.� � �.�,,�J <br /> I FiEREBY CERI7;�Y THAT�HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAINS AND ORIDINACES GOVERNING THIS 7YPE OF WOFK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR IOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED 8Y THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> l NC �li��'� �� Ia�Iot <br /> Signa�ure of wner/Conlractor/Authonzed Agent Oate �/Z <br />