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P�RA`11T APPLICA`TIGN <br /> CITY OF EVERETT PERMI�' SERVICES <br /> 3200 CEDAFi STREET, EVERETi', WA 98201 <br /> 425-257-8810— FA: 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.k `P�RMtT a ` <br /> � I �ID 5E ��mXll ��. � 2o S SIS oo� o��fl bo �`_��.'�/-Oa- <br /> LEGA LOT NO. BLOCK �RACT <br /> DES0. �ty(ml,Lj" �- � _ <br /> OWNER AODR[SS ZIP PHONE <br /> cc,a �w4�v��s � ►�- lo�oo M�d�- � ti , s��s, Sce.fffc rWl4 YP13J z°6�F�_ <br /> TENANTNAME CONTACTNAME , PHONE <br /> �'�,y��- �,v�u�o I Go wvu,U. Klcs���" V��lu�o���� '(as-�70-b7oG <br /> J <br /> CONTRACTOR ADDRESS 21P CONTR.LICENSE H <br /> ( �w� �5�'V���bu. ll �ro sE Evevttl WiaL� (� '�-lo ` p <br /> PHONE �I.w�WI l �� IQ�oO IZ,E��C/�ICI ` �'�J��1 <br /> N�s , �fzz - tZ9Z — <br /> PROPOSED USE OF BUILDING yJ Building Q Mechanical Q Addltion HEAT SOURCE <br /> ,. . • PERMIT K Combina�ion I ) Plum6ing WORK j�Q Alteralioo � Electric I <br /> 0�Y��� TYpE �� Demolilion � Sign 7YPE D New Gas <br /> IJ Sprinkler U Repair/Maint. Olher <br /> CONTRACT PRIC�OF WORK ���� CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> wea��caia��ioN �,t�w���Ld1A. Lpru�l- � c'v,�.�.u.�p � ' , .Stu�"ta`fn 5� dor-� t^*.���t <br /> c,�Q �.c."uJ � pAv�G�I. �G(A-�.U� �/ �(,�-�C. 3o6tu-�(�A�#5� Yt�,6t.c.lG �m <br /> a��u� c��wt-c�a�d • J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATERCLOSET _ A/C-A/HANDLINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> I _ OISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER FIEATER <br /> I _ CLOTHES VJASHER _ METAL FIREPLACE/STpVE <br />'^ I = URINA� � FIREPLACE INSERT <br /> DR�NKING rOUNTAIN GAS FIREPLACE <br /> ' FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/8AR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I I HEREBY CERITIFY THAT I HAVE READ AND cXAh11NED THIS APPLICATION AND KNOW THE SAME TO BE TFUE AND CORFECT. AlL <br /> IPROVISIONS OF LAWS AND ORIDINACE$G'JVERNING THIS NPE OF WORK WILL BE COMPLIED VJITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GFiANTING OF A PERh11T�OES'JOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF NNY OTHER <br /> �' STATE OR LOCAL LAW REGULATING CONBTRUCTION OR THE PEFFOf7MANCE OF CONSTRUCTION, THAT I AM AUTHORIZED ElY THE <br /> ' OWNER OF THIS PROPERTY TO PE9FOf,M THE'NORK FOR WHICH APPLICATION IS h1ADE AND I COMPLY WITH THE STATE <br /> CONTRAC�ORS LAW 1827 RCW AND 206200 WAC. <br /> Signature of OwnerlContractodAcihorized Agent Dale ,/ <br /> 2 <br />