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P��MIT APPLICATIG�J � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS Cb�U�'L$�l� qU� PARCEL TAX I.D.N PERMIT M <br /> a�3 i c-�.a Oosusoo reo.s- CoZG°(-G! <br /> LEGA LOT N0. BLO/�CK TRAC7 <br /> DESC. ��fZ I p P/N�/fbR.!'T– �/►'�J /0�.1 � <br /> OWNER // ADDRESS aP PI10NE <br /> Q,Ec-A�vA n,S��C f ,�( 3 / CG� lr�3F'1 , <br /> 98203 �f2S• 3o j ,UuS`� <br /> TENANfNAME CONTACTNAME PHONE <br /> _ I 2E�D �}A+�.►�� `t�21-303 ^OyJ 7 <br /> CON7RACTOR ADDRESS ZiP CONTR.LICENSEM <br /> PHONE ��j�''��A�Se'^J L�70/ 1J (�/C�V('IRJ� �Q �V. 1SZ�3 <br /> PROPOSED USE OF BUILDING Building Mechanical Addition MEAT SOURCE <br /> PERMIT �Combination � Piumbing WORK � Alleralion I7 ElectNc <br /> �j A/L,(� (�(_� TYPE Demolition Sign IYPE New � �1 Gas <br /> Sprinkler Fepair/Meint. V Other <br /> CONTRACT PRICE OF WORK ! �� CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION <br /> ('�Nvc� ��,,,«� '��.�wc, � 6��-Gc <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF Fl7(TURE OR ITEM <br /> _ WATER CLOSET _ A/C–A/HANDLING UNITS <br /> _ CiATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATEFS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _, DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> I _ URINAL _ FIREPLACE INSERT <br /> ; _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> � __ FLOOR DRAIN _ GAS RANGE <br /> � _ BACKFIOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER_ _ OTHER <br /> I — <br /> i — <br /> I — — — <br /> I HEREBY CEFITif-Y THAT I HAVE REA�AND EXAMINED THIS APPLICATION AND KNOW TFIE SAME TO BE TRUE AND COFRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WFiETHER SPEC�FIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOFITY TO VIOLATE OR CANCEL THE PqOVISION OF ANY OTHER <br /> STATE OR LAW qEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> �� OWNER THIS P OPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> �- CON W 18.27 RCW AND 296200 WAC. <br /> ! 4-zS= o�— <br /> � Sign re oi Owner/Contractor/Authonzed Agent Date <br />