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s� <br /> i� ERMIT A,PPL�CAT, JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SInE ADDRESS I PARCC•L TAX I.D.# PERMIT a <br /> 2 � 3U— f,�it.tb t�1�� EWc�1 S'�y'7- o/3 -013 'Ooa � I �3Dzr,7-o3 Z <br /> LEGA LOTNO BLOCK TRA T <br /> DESC. � � ( 3 �/.7JC .[�t '�5]� <br /> OWNER ADORESS ZIP PHONE <br /> C����`i Z 3 3��- /�o�,,,yR D ��9 Jes JSS- Y3� 6 <br /> TENANTNAME I CONTACTNAME PHONE <br /> � YYI�I�Ce� GoA�,'+- 'Lol.• �l�l- iZO� <br /> CONTRACT4R ADDRESS ZIP CONTR.IICENSE# <br /> PHONE ,n„I��S R/-�./j� //JC,. 'Lp(c �I�I'IZf�$ <br /> �'/ <br /> PROPOSED USE OF BUILDING I BUllding � Mechanical Addition H[AT SOURCE <br /> / I PEFiMIT � Combinalion Plumbing WORK R Alleralion Q Electric <br /> G y � TYPE DemOlitiOn Slgn TYPE D New �j Gas <br /> � � Sprinkler U RepaidMaint. U Other <br /> CONTRACT PRICE OF W.�RK �} L/ q �Z � CITY OF EVERETf LOCAL SALES TAX COOE IS 3105 <br /> q / / <br /> WORK DESCRIPTION <br /> � U � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM ��D. TYPE OF FIXTURE OR ITEM � <br /> _ WA CLOSET A/C-A/HANDLINGUNITS <br /> , _ BATHTU _ FORCED AIR SYSTEMS <br /> LAVATORY ( BASIN) HEAT PUNP <br /> � SHOWER — <br /> — _ UNI i HEATERS <br /> i _ KITCHEN SINK 8 DISPO _ CLOTHES DRYER <br /> ' _ DISHVJASHER RANGE HOOU <br /> � _ LAUNDRY TRAY _ WATER HEATER <br /> I _ CLOTHES WASHER MEIN.I FIRcPLACE/STOVE <br /> I _ URINAL FIREPLACE INSERT <br /> ' _ DRINKING FOUNTAW _ GAS FIREPLACE <br /> _ PLOOR DRAIN GAS RANGE <br /> 9ACKFLOW PFEVENTER GAS PIPING <br /> _ SINK(SER`/ICE/BAF/MOP/ETC.) _ EXHAUST FAN <br /> ' _ OTHER_ _ OT <br /> I HEREBY CERITIFY'HAT I HAVE READ AND EXAM1IINED THIS APPLICATION AND KNOW THE SAME TO bE TRUE AN�CORRECT. ALL <br /> PROVISIONS OF L�WS ANO ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SNECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERPdIT DOES NOT PRESU!AE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PFOVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGU ING CONSTRUCTION OP,THE PERFORldANCE OF CONSTRUCTION. ?HAT I AM AUTHCRIZEU BY THE <br /> OWNER OF 7HIS ROPERN 0 PEP.FORPd THE VlORK FOfi WHICH APPUCATION IS�dAOE AND I COMPLY WITH THE STATE <br /> CONTRACTOP W 18.2 C'N AND 296.200 WAC. <br /> �^ ��� �� <br /> Signawre o! r euContrector/Au�honzed Agent Date <br /> iA <br /> t <br />