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�' PE.�MIT APRLICATIG, � <br /> ! CITY OF EVEREl"T PERM17 SERVICES <br /> 3200 CEDAR STHEET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> I <br /> �� SITE AD�RESS � /�ARCEL TAX I.D.Il PERMIT# <br /> ` � d� .�0�/l3 ooa a�� rX� � �aoS -oo <br /> LEGA LOT 0. BLOCK TRACT <br /> oesc. 'dp�j —oD <br /> OWNER ADORE55 ZIP PHONE <br /> � l���r p�'/v-c �„ �cai r�d �-r sv�0 7�`� t'a� ��•y-���� , <br /> �? � �'-d�.R'�� �� /2� ?��.�aa �d, ` i`f�S <br /> TENA�AME I CONTACT NAME <br /> PHONE <br /> � � t1 <br /> CONTRACTOR �����/ O / � ���•/y��} <br /> ADOR SS ZIP CONTR.LICENSE# ' <br /> PHONE <br /> PROPOSED USE OF BUIL�ING I Building Mechanical Addition HEAT SOURCE <br /> PERM17IT R Combinalion � Plumhing IWORK R Alteration � Electric <br /> TYPE � Demolition Sign 7YPe D IJew I Gas <br /> Sprinkier U Repair/Mainl. Other <br /> � CON7RACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> Y/ORK�ESCRIPTI N <br /> ft�'�W-C,j.p �t�z .�,. �'�'"`�-- <br /> PLUMBING <br /> MECHANICAL <br /> N0. TYPE OF FI%TUFiE OR REM N0. TYPE OF FIXTURE OR ITEM <br /> I WATERCLOSET _ A!C—A/HANDLINGUNITS <br /> � _ BATHTUB _ FORCED AIR SYSTEMS <br /> I _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> ; _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRYTRAY WATER HEATER <br /> _ CLOTHES WASHER _ METALFIREPLACFJSTOVE <br /> _ URINAL FIFEPLACE IN.SERT <br /> __ DRINKING FOUNTAIN . _ GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SFRVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER_ _ _ OTHER <br /> I HEREBY CERITIFY'HAT I HAVE READ AN�EXAMINE�THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COFRECT. ALL <br /> PROVISIONS OF LA1VS AND ORIDINACES GOVERNING THIS NPE OF'NORK WILL BE COMPLIED WITH WHEfHER SP!_CIFIED HEREIN OR <br /> NOT. THE GRANTID�G OF A PERMIT�OES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL L1W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 9Y THE <br /> O'TJNER OF THIS PROPERN TO PERFORM THE WORK FOA WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOF\S 4 W�.. 7 RC'N AND 29fi.200 WAC. <br /> , ! I 7 _ ��� —G�� <br /> IS�tl f �ol tra r thorizedA t' ate <br /> C <br />/ <br />