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F'�.�RMIT �PPLICATIL N <br /> CITY OF EVERE�'1' PERMI'T SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98?.01 <br /> 425-257-8810 - FAX 425-'!57-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# I PERMIT a <br /> �02 .Jo�%�� 6��ZD5 �ZF� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNEA� + <br /> ADDRESS ZIP PHONE <br /> /,1 �,�/,-� �G���so�r/ <br /> �TENAN NAME <br /> CONTACTNAME PHONE <br /> ,:� �,����1��� �Cc.�Sor�/ �S%� � 9� <br /> CONTRACTOP. ADDRESS ZIP CONTR.LICENSE N <br /> PHONE <br /> ' PROPOSED USE OF BUILDING �ilding D Mechanical Addi�ion HEAT SOURCE <br /> ' PERMIT Com6inalion U Plum6ing IWORK Alteralion � Electric <br /> i TYPE Dem0lillOn U Sign 7vFE New Gas <br /> �Sprinkler i epaidMainL Other <br /> CONTRACT PRICE OF WORK O f}-U CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> WORf:DESCFIPTION <br /> � � �G!��� �c—C�/ MECH NIC� <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATERCLOSET _ A/C—A/HANDLINGUNITS <br /> � BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY ;WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _, CLOTHES DRYER <br /> I _ DISHWASHER = RANGE HOOD <br /> LAUNDRY 7RAY WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING rOUNTAIN _ GAS FIREPLACE <br /> FLOOA DRAIN GAS RANGE <br /> � _ BACKFLOW FREVENTER EXHAU3TFAN <br /> _ SINi<(SERVICE/BAR/MOP/ETCJ OTHER <br /> , OTHEF — <br /> �' —I — <br /> �, _ <br /> � I HEREBi CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GFANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE ON LOCAL LAW RECUIl+TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER QF THIS PROPERN TO PEFFORM THE OFK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />� CONTRA TORSkAW 18.27 RCW AND 96.200 W C. � <br /> / <br /> , . ' �. � t��-` '�C � �����- <br /> i `� � Date � <br /> Si nature of OwneNContractodAuthorized gem <br /> i � <br />