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F �RMIT APPLICATII.N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.M PERMIT M <br /> 3yiy Fvzrc�l# i¢v� oS 6$ 200 0o So3� a-dcl <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PMONE <br /> L•-eora�. Sf� u if 5023 G� 4►t p.; eti-/' f.i�fy Gv�.rc� _ <br /> TENANT NAME COM ACT NAME PHONE <br /> SA1 oo.J <br /> L; ��f- 1,o�s�.. �'�.�,f- S���� Pla.,� � �{zs- 776 - Fss 3s— <br /> CO RACTOR O`�_ NcoN � o ADDRESS Z1P CONTR.LICENSEN <br /> � 'y �o,Bw� s-z 6 S <br /> PHONE // p G �2lr Nc o 77GIs� <br /> �ZaS� 7�b' OFj3S� L��vNl..�O••DJ � � 6 � YL � <br /> PROPOSED USE OP BUILDING Building �echanical Addition I HEAT SOURCE <br /> PEPMIT Combinalion Plumbing WORK Alleration R Electric <br /> 7� vt� �✓ 7YPE � Demolition ign TYPE ew I �j Gas <br /> U Sprinkler Repair/Maint. U Other <br /> CONTRACT PRICE OF WORK 9�?Q O o CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> / <br /> WORKOESCRIPTION �ti�,�LL [/� F�A� MOu.�c1� SS �/ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR RE��I N0. TYPE OF FlXTURE OR ITEM <br /> W,�TER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ IAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIFEPLACE/STOVE <br /> UFiINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I <br /> i — — <br /> i — — — <br /> � I HEREBY CERITIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CGRRECT. AlL <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEPEIN OR <br /> ! NOT. THE GRANTING OF A PEPAtIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW qEGUL1TING CONSTRUCTION OR THE PERFORM1IANCE OF CONSTRUCTION. THAT I 4M AU7MORIZED BY THE <br /> � OWNER OF THIS PROPE TO PE M T OR� H APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> I CONTRACTORS LAW 1 7 R . 1 <br /> � ///��� ,, �^/ , Q��- <br /> i Sign e of OwnedConlractor/Authorized Agent Date / ,�" / � <br /> 1 V' <br /> L . � <br /> I <br />