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t <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf,WA 98201 <br /> 425-257-8810-FAX 425-257-885'7 <br /> SITE ADORESS PARCEL TAX I.D.!i PERMIT S <br /> 'Zt22 (,ow�bgrd �E Do4s�i 14�€ozzoo /�'t�'�d 9�-�i <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS 21P PMONE 2f= <br /> �4�P.►� ("jWe►1 7-('Lz I�� FWE FaJ'U'e�-F R S�t, I Z 1��i <br /> TENANTNAHE /CONTACTFORPERMIT PHONE <br /> �aW1� I u.1.Vll�,(C� �lk.��4.5� ��P �-$Z�l� <br /> ' CONTRACTOR ADDRE55 ZIP CONTR.LICENSE p <br /> w�.sv�c 2S�-n. �-'�y S�� , l-v�4S M I ES R� ! o i3 <br /> PHONEe�'OCQ 'J SZ.. � � � �l_4 L 7 [ <br /> , PROPOSEDUSEOFBUILOING BuilAing Mechanlcal Addltlon HEAT50URCE <br /> i pBRMIT R�..( COmbinatlon lumbing wORK ateraBon �I�y EletUlc <br /> � il'PE J.�j Demolitlon Sfgn IYPE New �{(j Gas <br /> U Sprinklef RepairlMalnl �L] Other <br /> CONTRACT PRICE OF WORK (,,,e�j�� ^' CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> WORK UESLRIP?ION /� <br /> ���� l c�45 � � `fv��2`cC�, -7 ��crUv fi�tc s <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTl1RE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER GLOSET(TOILETJ A/C—FVHANDLIN(3 UNITS <br /> BATHTUB = FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER _ METALfIREPLACElSTOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BARIMOP/ETC.) _ EXHAUST FAN <br /> OTHER _ 077�ER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAAIINED THIS APPLICATION AND KNOW TNE SAME TO 8E TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> N07. THE GRANTING OF A PERMIi DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF TMIS PROPERTY TO PERFORM TME WORK FOR WMICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CON7 CTORS 18.27 RCW AND 296.20Q WAC. <br /> ���,,]J ��(�%� b ��,4�0� <br /> S�nature o OwnedContrac Author2ed Age Date <br /> DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> i 'd zS88LS252bi�01 �WO?J� i£�22 £002-9i-d35 <br />