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� `ERMIT� APPLICA�"�ON <br /> CITY OF EVERETT Pl:RMIT SERVICES <br /> 3200 CEDAR STREET, EVEi�ETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N ERMIT w <br /> � � - � � C��la -�aa- <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PMONE <br /> /� �t�'�'ib <br /> �FN fs#o�tJ V �L U�q-!A1 a� ! /OC�a`i'- l9 � �T S�uouati�srf 3b0 5b8-'y3r� <br /> TENANTNAME CONTACTNAME PHONE <br /> �Ru�,�y P�U��� 36a5G8'- Y3�O <br /> CONTRACTORY_N�pGI/ A_N���,.y ADDRESS ���� Q�k /63,6 �P CONTq.LICENSEN <br /> G r-vy W <br /> PHONE �1�5 3q�7-�5ay o,���.r: I�cce� sTe�.��n;s `t$�s Eiv��:�qg9M <br /> ��s 5�n r� �j� ���! <br /> PROPOSED USE OF BUILDING Building MeCheniCal Addilion HEAT SOURCE <br /> PERMIT R�/ Combination Plurtlbi�g WORK Alteratlon Electric <br /> 7YPE �,J D�molitlon Sign 1YpE �eP �Gas <br /> U S rinkler e air/Mai. . L] Oiher <br /> CONTRACT PRICE OF WOHK CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> I WOHK OESCRIPTION � <br /> f�t p 1 a.c.� �k i s�, �t� i,�ra.�- h Qa f��- � G�s <br /> I <br /> � PLUMBING MECHANICAL <br /> INO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ' WATER CLOSET _ A!C—A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> __ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TFAY � WATER HEATER <br /> _ CLOTHES WASHEF METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> I = FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICFJBAWMOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNON/THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GPANiING OF A PERMIT DOES NOT 'RESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PflOVISION OF ANY OTHEA <br /> STATE OR LOCAL LAW REGULATING CONS7HuCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE � <br /> OWNER GF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE SThTE I <br /> CONTRACTORS LAW 18.27 flCW A 296.200 WAC. <br /> l � � <br /> S�r a ol wner/C n r ulh ed Agent Date � <br /> I <br /> I <br />