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PE�.MIT APPLICATIOP'. <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982G1 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADORESS pARCEL TAX I.D. X PERMIT a <br /> /oiosE ��r� /yq� wA SuirElao Zog �/8 Oo.3 oe6 00 9/� <br /> LEGA LOT N0. BLOCK TflACT <br /> oesc. ON T/.d GOV�-,e 5'/�EET <br /> OWNER ADDRESS ZIP FHONE <br /> TAME.S /'FLU�GE,e �� CotGiE�dS°a f�A,eBa2 fIE/G/�.I Ma,{��rEo� WA. �'81�j 759-/6yj <br /> TENANTNAME CONTACTNAME PHONE <br /> ln/EGGS FA,�GO E.�/C LG��NELT�� CONNELG A�S/�i� �JZjr�,��D �6 <br /> CONTRACTOR A ORESS ZIP CONTR.LICENSE li <br /> k/ey[EY-�o�E lola SE EvEQe�f�qc�. �v�iY SviTE /02 Eucas7lLv.a. I�I,�7-GCA27ZRF <br /> PHONE 9BlQ� EkF �-/-ZDa <br /> �-1z5- 60 9-O yo0 S <br /> PROPOSED USE OF BUIL�ING Building f"1 MeChaniCal Addition HFAT SOURCE <br /> PERMIT R Combination �� Plumbing WORK � Alteration � Electric <br /> d�(,£ TYPE D Demolition LJ Sign TYPE New Gas <br /> I U Sprinkler fiepair/Maint. Other <br /> i CONTRACT PRICE OF WORK � Q' L�C� CITY OF EVEFiETT LOCAL SALES TAX CODE IS 3105 <br /> V / 7 <br /> 1 <br /> WORK DESCRIPTION <br /> J�EMO /NTf„F.f72 WAGL.T/ NEW DOOQ/NEW INTE¢a2 P��T�i�a�S/P.4���F�.a74 FiNlSyE.f <br /> i PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ' WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> i = LAVATORY(WASH BASIN) = HEAT PUMP <br /> SHCWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> i _ LAUNDRY TRAY _ WAl'ER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> I _ URINAL FIREPLACE INSERT <br /> ' DRINKING FOUNTnIN GAS FIREPLACE <br /> FLOOR DRAIN GAS FiANGE <br /> '� BACKFLOW PREVENTER GAS PIPING <br /> � SINK(SEAVICEJBAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEFEBY CERITIFY'HAT I HAVE AEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS IYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> N07. THE GRANTING OF A PERMIT�OES NOT PqE5U1�1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PfiOVI510N OF ANY OTHEF <br /> STATE OR LOCAL LAW REGULITING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEFTY TO PERFORM THE WORK FOA WHICH APPLICATION IS tiIADE AND I COMPLY WITH THE STATE <br /> CONTFACTORS LAW 18.2��W ANDa9fi200 WAC. p <br /> %/� d T O '�0`Q <br /> / <br /> / i� /L <br /> Signawr�e o�uComractor/Aulhorized Agent Date /� <br /> ��v <br />