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i �� <br /> PERMIT APPLICATI��N <br /> i, <br /> j �p� CiTY OF EVERE7T PERMIT SERV(CES � <br /> j 3200 CEpAR STREET, EV'r_R�TT, WA 98201 i <br /> I 425-257-Efl t Q —FAX A25-'�57-8857 � <br /> ia-i�--�v i <br /> � SITE ADDFESS PARCEL TAX LD.# • �/P��EaA�i7 r I <br /> � ��I I.prY'�.r ., �� , ��:� �� ��A:-'v `I`,.�'( ` i, � �J�� il.l ,. C " <'IC�� l�� �U�� � Q�t7� <br /> LEGAI tDTNO. BLOCK TqACT.. � . I <br /> Dc:>C. � i .��l� �I� L �I V"i. C, l��i�ili��.� . A�. �'.�N' F� �i�.".,� <br /> ,i�. ,;.:e <br /> � OWNER AO�PESS TIP PHONE <br /> .i. . . II „ .�� h���.�h ���'.i.�.i �� i � � i'' . � .. . � . . .. . � _'i:�. � ,. I i; . . '�'i � <br /> i, 1 <br /> I TEfJANT NANE A COMACT NAME T PHONE � <br /> � <br /> � (, � ..�� . � � <br /> . . _ _ �_ _._.___.____��'_—_._— _..___, <br /> CUNTR C fl AbpqESS ZIP GOMR.LICENSE X <br /> I !-���+Y-a.THsi�� y�.z9 c� i`t6 S"' �d'036 � <br /> / '/ ,1 � � � <br /> PHONE L�Z� `/��^(J y3`F ���{lJ/1�GviJ V� �li�tR.�� rJII � I <br /> � PROPo5E0 USE OF OUILOING i n6wlding (�'MBChefllCel AdCitiCn MEAT SOURCE I <br /> ; PERMi7 � CPmbination F`� Plumhing �WORK R,AllPalian I � Elxtdc � <br /> � I TYHE Dcinolluun U S�gn nPE � New Gas � <br /> S rinlder Re .!tlMflint. Olhar I <br /> ICnNTRAc7 PRICL OF WOflK �� ♦ �: ��� �,�.� CITY OK EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> I tYORN DESCRIPYION <br /> � S�I�S%�"(L 1"�"u���-�� — �fOJ US �✓G `�Lr�/AIUr�J/ <br /> I Y <br /> � <br /> I � <br /> PLUM8ING MECHANICAL I <br /> ' id0, TYPE OF FI%TURE Op ITEIA N0. TYPE OF FIXTURE OR IiEM I <br /> i <br /> � WATE(7 CLOSFT _ A/C–NHANDLING UNITS � <br /> � � DATHiUO � FORCED A�R S'fSTEMS <br /> j �_, LAVATOf1Y(�NASH�ASIN) HEAT PUA4P <br /> _.� SHOWEH UNI7HEATERS <br /> ��. _,_ KITCHEN SINK&D!SPOSAL CLOTNES DRYER � <br /> ___ DISHWASIIER RANGE HOOD � <br /> �, ._ IAUNDRY TNAY WATER HEATER � <br /> _ CLOTH[S WASHER � MFTAL FIREP�ACEISTOVE I <br /> ,,. L1RiNAL FIHEr'Lf10EiNSEfii i <br /> __ ORINKING FOUN'iAIN _ GAS PIREPIACE <br /> _ FLOOR DRqIN GAS RANGE I <br /> . __ BACKFLOW PRFV[NTEF T G.4S PIPING � <br /> _ SINK(SEHVICk/(�AR/MOP/ETC.) EXHAUST FAN <br /> _ UTfiEF OTHER <br /> -- — • L Id7CU 'rt�— <br /> __ I <br /> — — i <br /> !�^.'EREGY CERIT;FY TW.T I HAVE RGO AtiD EXAMl4ED THIS APPIICAIION M��KNOW iHE SAME TO BE 7RUE ANO COPRECT. ALL �I <br /> I=i7GVISIONS OF lAWS AP7�ORIDINACES GOVERNING THIS 7YPE OF WORK WILLBE COMFUED YJITH WHETHER SPECIFIE�HEFFIN OR I <br /> rCT. THE GFlANTING OF A PERId1T OOES NOT PRESUA7E TO GIVE Al1TNORITY 70 VIOLATE OR CANCEI THE PROVISION OF ANV Ol?tER <br /> :T�7E OR IOCAI LAW REGULATING CONSTRUCTiON OR THE PEFFCAntqN;E OF CONSTPUCTtON. THAT I AM AUTHOF12ED AV TH[ , <br /> ClL't;C�OF TN13 PAOA[i9TY 70 PERfORA17t1E WOfiK FOH WHIGH APPLIi.AiIUN�$MAUt AN01 COMPLY VJI7H 7HF STATE � <br /> . CONTRACTOAS LAW 18..7 flCW AND 258.^<00 WAC. � <br /> �u� \_• ��--�- �' ' � � � I <br /> wre oi wncrlGanlr�tlor/Aulhorized Agent �^ aC*to I <br /> I <br /> _-_—_. _ . __ . '_—_. _.____ . ._ . . '__. .. . . . ._" . ____ . . _.__�_"_ _ _. .. _ _. _ _. _= <br />