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P�r�MIT APPLICATIC��J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> 2vg - O�� <br /> SITE ADDRESS PARCEL TAX I.D.N PERMiT♦ <br /> 10/2 tof� wAY Ou S• 5 a�-I rx�c� - U I �cU Co -C� <br /> LEGA� LOT NO. BLOCK TRACT rjP� <br /> oEs°. Ia oa �ib - a� <br /> OWNER �I�S� n _ - ADDRESS 2�P pHONE <br /> b�-v <br /> ,� _ . � � l n i �� � � � GJAg. �8�- <br /> TENANT NAME CONTACT NAME PHONE <br /> I�Tasha H,ga. �4as� �5y os� 7 <br /> CONTRACTOR LIfeSlyle N��M*� �CUnSE. ADDRESS ZIP CONTR.LICENSEN <br /> L2�EsxcvMykr <br /> PHONE 3�0- �5a - iq75 <br /> PROPOSEO USE OF BUILOING Building f'1 Mechanical Addition NEAT SOURCE <br /> SFR PERMIT Combination �_� Plumbing WORK nueration Eiectnc <br /> TYPE Demolilion LJ Sign TYpE � New � Gas <br /> Sprinkler U Repair/Maint. Other <br /> CONTRACT PRICE OF WORK �QUI � � CITY OF EVFRETT LOCAL SALES TAX COOE IS 3105 <br /> / <br /> WORKDESCRIPTION ��S�C�� D�' �� S�/� C.Q �«rn,'I,.,� /Ql��G�,�t,�, <br /> /�c. �av� J <br /> PLUMBING MECHANICAL <br /> I NO. TYPE OF FIXTURE OH REM NO. TYPE OF Fll(TURE OR REM <br /> � WATER CLOSET � A/C–A/HANDLING UNITS <br /> ; �' _ BATHTUB _� FORCED AIR SYSTEMS <br /> ' 3 LAVATORY(WASH BASIN) �Q� HEAT PUMP <br /> I � SHOWER � UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL � CLOTHES DRYER <br /> 1 UISHWASHER I RANGE HOOD <br /> I �' LAUNDRY TRAY WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> ` URINAL FIREPLACE INSERT <br /> OAINKING FOUNTAfN _� GAS FIREPLACE <br /> FLCOR DRAIN (O GAS RANGE <br /> BACKFLOW PREVENTER �— GAS PIPING <br /> SINK (SERVICEiBAR/MOP/ETCJ � EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY?HAT I H4VE RF�1D AND EXAMINED THIS APPUCATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS GF W WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEiiEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUAIE TO GIVE AUTHORITY TU VIOLITE OR CANCEL TNE PROVISION OF ANV OTFiER <br /> STATE OR LOCAI L1W REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT i AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PEPFORM THE WORK FOfl WNICH APPLiCATION IS h1PDE AND 1 COM1IPLY WITH THE STATE <br /> CONT,�R�C,)ORS WW 18.27 RCW AND 296200 WAC. <br /> �i._1-� � /� �I(-,--�- y �,�`7 •o� <br /> Signawre ol OwneUContractnNAulhonzed A nt 1 Date ^ , <br /> � `�� <br />