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P4�RMIT APPLICATinN <br /> I ��s�-� CITYUF EVERETT PERMIT � EhVICES <br /> �U 3200 CEDAR STREET, EVERETT. 4�ry1 98201 <br /> d25-257-8E10 - FAX 425-257-885? !,\O � � � _ O(U� <br /> c <br /> iSITE i,DDRESS PARCEL TAX I.D. # I FERCIIT 7 <br /> I _ �—�� ��–�Qi-1$�(��--^�' �'�U' �'O�Z.--O{�— <br /> LEtnn LOT NO. � BLOCK TRACT <br /> DESC. — Q <br /> 04VNER ADDRESS ZIP PHONE <br /> � A r�>+ 71'o r� � (.�GvG I o(�Na��u7' i /��o � �'iz. ���f' J5T/-- <br /> 0 <br /> TENl1NT NAG1E COt�TAC7 NAP,tE PHONE <br /> _ f�/�-; _ SG����j�l, � <br /> COIJ7RACTOR A�DfiESS ZIP CONTR. UCENSE N <br /> �AT2-r �Tr� a� �r�FtT�c�� s�..� z�o�7 7�-n' f�d� <br /> PHONE .—+-r <br /> ( Z'� ;': ? '13�- ��'> 1 t-Acs�!✓?�C � �,{J� � ��-2�- � <br /> ��i�-T(Z i F"t-�?� <br /> PROPOSED USE OF BUIL�ING Building fl Mechanical Addilion HEAT SOURCE <br /> PERh11T COmbinatl0n K Plumbing WORK Alteration � Electric <br /> 7YPE Demolition U Sign NPE New Gas <br /> ���'��'� Sprinkler RepaiUMainL Other <br /> CONTFiACT PRICE OF LYOf�K dJ �� ��V �� CITY OF EVEFiEfT LOCAL SALES TAX COOE IS 3105 <br /> J/ � <br /> VlORK DESCFIPTION <br /> '(�f;Jfr� JJ �NiO �N5TQ11 '� �:� -�.�(I �'� I"� 1E�CS <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C—NHANDLING UNITS <br /> _ BATHTUB _ FORCED AIR S'ISTEMS <br /> LAVATOR`f(WASH BASIN) HEAT PUtitP <br /> � SFiOWER UNIT HEATERS <br /> KI7CHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> D!SHWFlSHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METALFIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN CAS FIREPIACE <br /> FLOOA DRAW G4S RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK (SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> i = OTHER_ = OTHER <br /> I — – – <br /> ( I HEREBY CERITIFY'HAT I HAVE REAO AND EXAMWED THIS APPLICATION AN�KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF lAWS AND ORIDINACES GOVERNING THIS TYPE OF WORN b'lILL 6E COMPUED WITH WHETH[R SPECIFIED HEREIN OR <br /> � N07. THE GRANTIPIG OF.4 PERPdIT�OES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE GR CANCEL THE PROVISION OF ANY OTHEA <br /> SiATE OH LOCAL LAW RECiULATING CONSTNUCTION Ofl THF.PERFOPMANCE OF CONSTRUCTION. THAT�AM AUTFIORIZED 6Y THE <br /> OWNER OF THIS PFOPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COAfPL'f WITH THE S7ATE <br /> TRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> i <br /> Signature of OwnedCcntractodAuthorized Agent Dala <br /> 7 Y <br /> _ �j�i .S ., <br />