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P RMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX a^5-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.ri PERMI7 a <br /> 2 3 ' �ln�lo�) I '7_��(� l�Za� ��7 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER f�,i,/�, f� ��(�J /G �-CrCYlif�f'S AODRESS 21P PHONE <br /> ;�,�f <�z� <<,i�y��� ��z�:� ��.t 9�Z��� �L=«�-����� <br /> TENANT NAME CONTACT NAkiE P.`iONE <br /> CONTRACTOR �CL CG(17�q(�1C�il ADDP,cSS ZIP CONTR.LICENSESI <br /> �S�,�v1ce � Iv�L 1�-fL�S"5�. 37t"-S� s�2G0 <br /> PHONE �ZS- �54 - kDZG� i3ri )e���c 9�i��?� F�1CC'.�5� 099 Nl� <br /> PROPOSED USC OF BUILDING Building fl MechaniCal Addition HEATSOURCE <br /> FcRMIT RI--( Combinalion �_� Plumbing WORK Alte�ation Q Electric <br /> TYPE �j Demolition LJ Sign TYPE New Lj Gas <br /> U Sprinkler Repair/Maint. L� Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> WORK DESCRIPTION - <br /> ���,��1 � �1� R�.�� �����,�j <br /> PLUMBING MECHANICAI_ <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTU9E OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY (WASN BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK� DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAI�v GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER_ OTHER <br /> I _ — — _ <br /> I <br /> I HEREBY CERITIFY THAT i HAVE PEAD AND EXAMINED THIS APFLICATION AND NNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> i NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME 70 GIVE AUTHORIN TO VIOLATE OR CA�CEL THE PROVISION OF ANY OTHER <br /> ISTATE OR LOCA�lAW REGULATING CONSTHUCTION OR THE PERFORMANCE OP CONS7Rl�CTION.. THAT I AM AUTHOFIZED BY THE <br /> OWPJER OF THIS PROPERTY TO PEHFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CO��TRACTOFS LAW 1827 RCW AND 29fi200 WAC. <br /> S!gnawre of OwneUContractodAuthorized Agent Date ,,,�/U <br /> � S�JJ' <br />