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P� iMIT APPLICATIC � <br /> CITY OF EV�RETT' PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 99201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PAACEL TAR I.D.# PepMn'a <br /> � ;� 1 Q /Gt� &�-D(� <br /> LEGA LOT NO. B�OCK 7AACT <br /> DESC. <br /> �__� <br /> OWNER - ADDRESS LP PNONE <br /> ��r,c�h S. �.��C\�c�l-� l �rn�v2d (a.�2. �'i b�l a53- ��t�co <br /> TFNAN7 NAME I CO!VTACT NAME pHONE <br /> �,� G���- Mc���l <br /> CONTRACTOR ('�_`�,^��-.�'..s�_,,�G� ADDRESS ZIP CONTR.LIC!SIJSEN <br /> t—'C.- 1 <br /> � PHONE `�LlnC1 . � �a ���1w� ��- C �O� <br /> �I a5 �s � - � �ti�� DAQ/� LN-A99�a�" <br /> PROPOSED USE OF BUILDING Building Ir�' Mechanical Addi�icn HEAT SOURCE <br /> PERMIT R Combinalion �� Plumbing WORK �Alteralion � Electric <br /> TYPE D Demolilion IJ Sign TYPB � New Gas <br /> U Sprinkler Repair/Miint. Other <br /> CONTHACT PRICE OF WORK � � �� � � CITY OF EVEREIT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION � <br /> �Y�`J�ZJ��\ �t� � (�1 V�12J �(1 Y`C5�� <br /> PIUMBING MECHANICAL <br /> NQ. TYPE OF FIXTURc OR ITENi N0. TYPE OF FI%TURE OR ITEM <br /> _ WATEHCLOSET _ A/C—A/HANDLiNGUNI7S <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> ,_ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KlTCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> � DISHWP,SHER RANGE HOOD <br /> LAUNDRY TRAY _ 1NATER HEATEH <br /> CIOTHE3'NASHER _ t�^ETAL FIREPLACE/STOVE <br />� _ URINAL FIREPIACE WbERT <br /> DP.iNKING FOUNTAIN � GAS FIP,EPLACE <br /> _ FLOOR 6RAIN _ GAS RANGE <br /> _ OdCKFLO�V PREVENTER _ GAS PlpING <br /> SI�JK(SERVICGBAWMOP/ETC.) _ EXHAUS�FAN <br /> i � OTHER �c 07H�R ���2�2 <br /> ' (�1,, an� <br /> ^ I . <br /> �, I HERE�V CERiT�FY THAT I HAVE READ AND EXAMINED THIS APPLICP.TION ANO KNOW TFiE SAME TO BE TRUE AND CORRECT. AlL <br /> ' FFOVISICNS GF I�tWS AND ORIUINACfiS GOVERNING THIS TYPE OF WORK WILL BE COMPUED WITH WHETHEF SPEC�FIED NeREIN OR <br /> ' NCT TNE GFiANTING OF A PERh11T�GES NGT PRESI�ME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISICN OF ANY 0T4Efi <br /> SiATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> ' vWKER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH A?PLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS lAW �827 RCW AND 296.200 WAC. <br /> � � �Z�C� � ��v �Ga <br /> gnatur OwnerlConlractor/Au;horized Agent Date <br /> �-- <br />