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P�RMIT APPLICATI(`N <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425257-8810-FAX 425-2.57-8857 <br /> i�.�c <br /> SITE ADDRESS PARCEL TA%I.D. N PERMI7� <br /> � Zo,� Se EVEe.ETI (nFli� ti+�q� I Zt'��� Sa� 'io4'b�o I CC�3 Gio_G/� <br /> LECJLL LOT NO. BLOCK TRACT <br /> DESC <br /> O'lVNER ADDRESS ZIP PHONE L12�� <br /> �buc� C �em�� ZssoN �t i �r�iT" � D�v��.� �J� • 9���� �aa�t��9� <br /> TEMANT NAME I COIlTACT FOR PERMT PHONE <br /> ZO� <br /> 5 H x s -t� - t=� r' Ja�t�► �t uro�.=5 � � (.5l"1 <br /> COI(TRACTOR C��7JS!tiJL�0/.� A��ESS DF CONTR 110ENSE N <br /> Nut;Hc> Z2� �q ►:c Lot ST <br /> P}1Q " WmDiNv�u.c� WA ' �'dnl� HUbHCC,)'O�IMi <br /> � PROPOSED USE OF BUILpNG Bw�dng?( � Mechamcal Addilion I NEAT SOURCE <br /> ! ( PERFMT � Combnation Plumbng woRK � Alteration� � � E�ectnc <br /> 7YpE Demd�Oon Sign 7YFE New I � <br /> Spnnkler Repair/Malnl � Olher <br /> � �T��PR�C��W�� � S �DO() ��� CR7 OF EVERETf LOCAL SALES TA7(CODE iG 1706 <br /> WOR1C pE`�CPoPTIDN — .- <br /> i �u�,�, i�., P w�c•. rNr . � . <br /> DE,�{p. Eri5T�/-�Io lJ.au.ti llew FimG M-�N�sN�'� .�� ,id i+::'�-' O�tLtt.� - �fsi�l-�li✓� <br /> �llq+s�r� - �k�W�u4 i-�C �tli 7eiA%� �nU=S <br /> ' PLUMBING MECHANICAL <br /> Iq. TYPE OF FIXTURE OR ITEM NO. TYPE OF FlXTURE OR REM <br /> WA7ER CLOSET A/C-A/HANDLING UNITS <br /> BATFITUB FORCcD AIR SYSTEMS <br /> IAVATORY (WASH BASINI HFAT PUMP <br /> SHOW£R UNIT HEATERS <br /> � T KITCHEN SIN4;8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> � LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER ME-TALFIREPLACE:�TOVE <br /> URINAL FIREPLACE INSE�2T <br /> DRINKING FOUNTAIN GAS FIREPLACt: <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIFING <br /> SINM,(SERVICE/BAR/MOPrTC ) EXHAUST FAN <br /> OTHER OTHER <br /> ' I HEREBY CERITIFV TMAT I HAVE READ AND E%AMINED TfiIS APPLICATION AND KNJW THE SAME TO BE TRUE NJD CORRECT. ALL <br /> PROVISIONS OF LAVJS AND ORI�iNACES GOVERNING T41S NPF OF WORn WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT THE GRAN7�NG OF A PERIA:T DOES NOT PRESUME TO GNE AUTHORITY TO V�OIATE OR CANCEL TFIE PROVISION OF ANY OTHER <br /> STATE OR LOCAL lAW REGULATING C7NSTRUCTION OR THE PERFORIMNCE OF CUNSTRUCTION 'fkiA7�I AM AUTHORIZED BY THE <br /> ONRJER OP TW S PROPERTY TO PERFORM THE WORK FOR 1MiICH APPLICATION IS MqpE AND 1 COIdPLY YdTH THE STATE <br /> COM TORS(AW 19 27 RCW AND 295 2(Y]WAC <br /> ( b � � 3 •a3 <br /> pnatur o erl.,onlracYod ulhor¢ed pent ale � ! <br /> \' DEBIT 8 CREDIT CARDS ARE IVCT AG-��:PTED � � <br /> L03 C)Cv - UI � <br />