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� �.• PcRMIT APPLICATIU�1 <br /> �� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> � - ag -o?� � <br /> SITE ADDRESS PARCEL TAX I.D.% PERh11T� � <br /> 2 Z �/�dc�S S�`z�� I���`�- G' � I, <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OW�jER .� � ADDRESS :' PHONE <br /> �6�J1G c��l t����"f N/,er�hU LLG��(7�D �f`'l�kt C 2 .�l�`--�G` <br /> I<ent «1A 98�)3 _ I <br /> TENANT NAME I � CONTACT NAME : PHONE I <br /> � /� kU ✓t�� �, � P Lr�!'e ��� . ( il�"� <br /> CONTRACTOR DDRESS : CONTR. LICENSE� ', <br /> Ct�r„nv-Uo�.( �� �r��ce-�c¢� �v P�X lZ8 ,L� 2 ' � <br /> PHONE 2 . " �'1 mO�-� �G r IG� �� l ��Z�✓ : <br /> �J (J <br /> iPROPOSE[�USE�OF BUILDING [� Building � Mechanical Addition HEAT SOURCE <br /> '����� �� � /�//�� PERMIT �j Combination Plumbing WORK Alteration Electric <br /> � � C� .��/ i�/�- TYPE u_Demoli�ion Sign TYPE Nc�v � Gas I <br /> a L�$prinkler Repairih1aint. U Other <br /> CONTRACT PRICE OF WORK 7� C�TY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> WO��SC�IPTIOt�j+(,Y I � � � � "/�yf �� S�� 1 � f I�IJ�-�� U Y��/Y \ <br /> S �� �/�/� � <br /> � <br /> PLUMBING MECHANICAL i <br /> NO TYFE OF FIXTURE OF ITEM11 NO. TYPE OF FIXTURE OR ITEh1 <br /> WATER CLOSET N'C-A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS i <br /> LAVATORY (WASH BASIN) _ HEAT PUMP � � <br /> SHOWER _ UNIT HEA7ERS <br /> KITCHEN SINK 3 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHEFi _ RANGE HOOD <br /> LAUNDRY TRAY _ NJATER HEATER �� <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT i <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PReVENTER _ GAS PIPING <br /> SINK(SERVIGE� R,'h10P� TC. _ EXHAUST FAN . <br /> oj OTHER _ OTI,ER I <br /> i <br /> �� I HEREBY CERITIFY THAT I HAVE RF11D AND EXAAIINED THIS APPLICATION AND KNONJ THE SAP,fE TO BE TFUE AND CORRECT. ALL I <br /> �� pqOVISIONS OF L1W5 AND OFIDINACES GOVERNING THIS TV'PE OF WORK WILL BE COIdPLIE�WITH SVHETHER SPECIFIED HEREIN OR � <br /> � NOT. THE GRANTING OF A PEAM1IIT D06S NOT PRESU�dE TO GIVE rUTHORIN TO VIOL4TE OR CANCEL THE PROVISIOi!OF ANY OTHEF , <br /> I $7ATE OR LOCAL L1lV REGUV.TING CONSTRUCTION OR THE PERFOFf.fANCE OF CONSTRUCTION. �iHAT I A�d AUTHORIZED BY THE 'i <br /> OWNER OF THIS PFOPER�'TO PEPFOR61 THE WORK FOR IVHICH APPUCATION IS M1tADE AYD I COh1PLY 5^JITH THE STATE ' <br /> CO�T�FS LA'N 18�7 RCW ANO 25o2C0 WAC. ' <br /> �,� Qi�� � 2� � � <br /> �, ,; <br /> Sign�tu e ol wneuContractorlAuthorized Agent Dare �/L <br />