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� P RMIT APPLICATIO�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> SITE ADDRESS PARCeL TAX I.D.M PERMIT 8 <br /> �Jolq lo� i� 1�Q• Eu�`�f/ (�63 2- vvo �a - <br /> LEGAL LOT NO. BLOCK TRACT /� <br /> DESC. '�F'1,��?2I CS ( �ii ._ <br /> OWN[R ADDR�:SS PHONE <br /> TfPkd1+ lJPdC�q�MI�` LLr I �0 gn �( �o�,g /11H �C��FPo wfl y��� � 7.5 y��g boS�g <br /> TENANT NAME <br /> ' CONTACT NAM'� PHONE <br /> N//� IS'r Il,' Ga P,� � �/z s a' 6 os� <br /> CONTflACTOR'r/PI�G�f �Pc�CIc�/��n� ADDRESS CONTR. LICENSEM <br /> �v g� X � zS -r/'eKa�lC `1�iz8/�{ <br /> PHONEG�ZSy� SboS 2� /�I(,�Ki �� (� li✓11 � yZ � S <br /> PROPOSED USE OF BUILDING � Buitding � Mechanic�l � Addition HEAT SOURCE <br /> PEAMIT Combinatian Plumbing WORK Alteration �Electric <br /> TYPE Demolition Sign 1YFE New Gas <br /> Sprinkle� RepaidMaint. Other <br /> CONTRACT PRICE OF WORK � �p� CtTY OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION �u� (� n e � � �.�I l� �C ,355 �� <br /> ZoX Zz <br /> 13A� l � � r� <br /> pLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR ITEM NO. TYPE OF flXTURE OR ITEM <br /> � WATER CLOSET A/C—A/HANDLING UNITS <br /> � BATHTUB � FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT?I�MP <br /> SHOWER UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> _� DISHWASHER �._ RANGE HOOD <br /> LAUNDFY TRAY ..2_ WATER HEATER <br /> Z CLOTHES WASHER METAL FIREPLACEISTOVE <br /> � URINAL � FIREPLACE INSERT <br /> _� DRINKING FOUNTAIN Z GAS FIREPLACE <br /> 0 FLOOR DRAIN GAS RANGE <br /> BACKFLOW PFEVENTER / GAS PIPING <br /> O SINK(SERVICE/8AR/MOP/ETC.) ll� EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY THAT i HAVE READ 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 COMPLIEO WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GFiANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OF CANCEL THE PROVIS�ON OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNEfl OF THIS PROPERTY TO PERFOFM THE WORK FOR WHICH APPLICATION IS M:.DE AND I COMPLY WITH THE STATE <br /> CONTRACTORS W 10.27 AND 296.2 AC. / <br /> ,,/J ( 2 <br /> Signature of Ow /Contractor/Authorized A t �1e 7 —o/ ��L <br /> I� � <br />