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�'�RMIT APPLICA�"'�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> �200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS ( PARCEL TAX I.�.# I PERMI7 x <br /> �J I `L- L ' ' i-1 V� 004-�i fl0 -7`I-I '-d0 G.� - O O <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. � •� � <br /> OWNER ADDRESS � ZIP PHONE <br /> . ` 232�oy Nc l�M 5f- q��) 33��~/1loU <br /> � � al�tcwc�l � S � I-�ct�e_� i.(lnnaie:vi Ilc_�(!A- �l�'io"1� � <br /> TENANTNAME CONTACTNAME � PHONE <br /> N//� /�'� r �ca- �a�r�bS (=fz-�) 330•-17luo <br /> CONTRACTOR (� I ADDR�SS . / /� ,,/ ZIP CONTR.LICENSE il <br /> /�FF���lr�blc /1�/�/C�1'ICi� I� LNL 37JL 5�71/ r�� l'Y�/l� /r/� �rra.��/''T/��0 �.� <br /> PHONE �v��r ff l�L� �} S�L�! � <br /> l42 z� 3 e3 - E:�7Z- - <br /> PROPOSED USE OF BUIL�ING fl Building fl Mechanical Adtlition HEAT SOURCE <br /> PERMIT 1� Combination �_� Plumbing WOFK R Alleration n Electric <br /> TYPE ps( Demolilion LJ Sign TYPE � New D Gas <br /> ��Me�r�ie�v �LJ Sprinkler Repair/Maint. U Other <br /> CONTPACT PRICE OF WORK CITY OF EVERE7T LOCAL SALES l'AX CO�E IS 3105 <br /> 3, 'Lro.oi: — <br /> WORK DESCRIPTION <br /> , �. ' s C� <br /> �<�r�c�, �i'o,v uF C-x�s�{,�� Sf,�.�� � u�� e �i'„�/ ew<� <br /> I ��� �•,L L,.vv <br /> LUMBING MECHANICAL <br /> �I NO. TYPE OF FIXTURE OR REM NO. TYPE OF FIXTURE OR ITEM <br /> j _ VJATEA CL�SET _ A!C—A/HAND�ING UNITS <br /> ' BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> � DISHWASH[i� _ RANGE HOOD <br /> ', LAUNDR'f'�RA� _ WATER HEATER <br /> CLOTHES WASHE� _ METAL FIREPLA.;E/STOVE <br /> I URINAL _ FIREPLACE INSERT <br /> DFIINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN __ GAS RANGE <br /> 9ACKFLOW PREVENTER _ GAS PIPING <br /> SINK (SGRVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHEA _ OTHER <br /> I HEREBY CEPITIFY'HAT I HAVE REFD AND EXAMINED THIS APPLICATION AND KNOW THE SAPGE TO BE TRUE AND CORRECT. ALL <br /> PRGVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK NfILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. ?HE GRANTING OF A PERMIT DOES NOT PRESUA1E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY UTHER <br /> STATE OR LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF:ONSTRUCTION. THAT I AM AUTHORIZED BY THE i <br /> OWNER OF THIS PROPER7Y TO PERFORM THE WORK FOR WHICH APPLICATIO�'S MADE AND I COMPLY WITH THE STATE <br /> CONT ACTORS LAW 18.?7 RCW AND 296.200 WAC. <br /> c - ���� �GGr � 1 /</ i8�o� <br /> Bi alu ot wnedContract r/Authorized Agem Date <br />