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� P�RMIT APPLICATIi.N <br /> CITY (�F EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX�.D.# PER T e <br /> ���o� L-,lc2cr� /-1�:� oos23663$ooS�o 20 �� — <br /> LEGA LOT NO. p BLOCK 7RACT <br /> DESC. C� Ej,3`� SU�ALIJ��:L�..S � n�0 �n� <br /> OWNER r AODRESS ZIP PHONE <br /> SNs.v��_� ll��J ��r�.�._ti 3006 c�;� � ,-� Avr 9sZo, 9ts -�os -3 •rz � <br /> TENANTNAME CONTACTNAME PHONE <br /> _ sA,.,«��?�.:; -s�--�,}-rr��� �u�,-.vra�lo'1 N��-3`i`(-4�10 <br /> CONTRACTOR / ADDRESS ZIP CONTR.LICENSE M <br /> ri+.l t y 1-) �.?-�c� C.�`..�/i i V Z"�� ��= T!'� �L. Q"��- <br /> PHONE tiv�2y:oT« r �� . `lSz �� � �-2.-1TSZLpfa9�3�- � <br /> PROPOSED USE QF BUIL��ING ,tr�� Building f"1 Mechanicai Addition HEAT SOURCE <br /> �a ^` ` PERM17 '� ) Combination �_� Plumbing WORK e Atteration � Electric <br /> S=`��^�'– � / TYPE Demolition Ll Sign 7YPE I )_New Gas <br /> �Z,y j B Sprinkler �P�Repair/Maint. Other <br /> CONTRACT PRICE OF W JRK "���� �� 7 751b � CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> �� Ju.%n�iSs.,; %2�(Jax� `: . �: ..� VoS�z.J .– A.Ja !'TC�t � A.�O FJc-� ,S�Lr1i Lti-� . <br /> �}tJJ OdOEa.-F� Gu.` Aaa r»Ts � 5.�5✓ t.�.Trr�� . <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF Fl%TURE OR REM N0. TYPE OF FI7(TURE OR ITEM <br /> I WATER CLOSET A!C–AlHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> OISHWASHER _ RANGE HOOD O� <br /> LAUNDRY TRAY _ WATEF HEATER /�� <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE V �� <br /> URINAL _ FIREPLACE INSERT �C� ��� � <br /> DRINKING FOUNTAIN _ GAS FIREPLACE � �� <br /> FLOOA DRAIN __ G�S RANGE � <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICElBAFUMOP/ETC.) _ EXHAUST FAN <br /> OTHEFl OTHER <br /> I HEFEBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AN�KNOW'THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPIIED WITH WHETHER SPECIPIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF COPlSTRUCTION. THAT I AM AUTHURIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> �-�--~`��� 6,1� �p z <br /> jgnalure of'OwnedContractodAuthonzed Agent D�— �/ <br /> , y <br />