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, <br /> P�RM17 APPLICAT{ON <br /> CITY OF EVERETT PERMIT �SERVICES <br /> 3200 CEDAR STREET, EVERETT, �VA 98201 <br /> 425-257-8810- FAX 425-257-f3857 <br /> SITE ADDRESS PAFCEL TAX I.D.# PERMi7 a <br /> 3vac� n�o,��� R�� mozo3 - or,R� <br /> LEGA LOTNO. BLOCK TPACT <br /> DESC. <br /> OWNER A�OFESS ZIP PHONE <br /> !�� Jo��s 3 vaol�.�.�r� /�� c 9���� '7�15--a5'S-53�� <br /> TENANT NAME I CONTACY NAME PHONE <br /> CONTRACTOA ro,f-j, y�,�,f-f/J/C AOORESS IG//F. /�'10��n . ZIP CONTR.LICENSEM <br /> ��r�rcti-• S � 1/i�%.., /J. `JSaGJ �UEi(GSSoJ ]or <br /> PHONE <br /> ,�-51-3��y <br /> PHOPOSEO USE OF BUILDING I f� Building �„J�AeChaniCal Addilion HEAT SOURCE <br /> PEpMIT �.� Combination ��_� Plumbing WORK Alteration Electric <br /> TYPE �J Demolilion LJ Sign TYPE New �Gas <br /> L� Sprinkler Fepair/Main1. Olher <br /> CONTRACT PRICE OF WORH 'b0 9 CITY UF EVERET�LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCflIPTiON <br /> ��' S.r"' �" «.,al��wr <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET NC—A/HANDLING UNITS <br /> BATHTUB _� FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATEFS <br /> KITCHEN SINK 8 DISPOSAL CLOI'HES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY 1_ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE IfJSEHT <br /> DRINKIfJG FOUNTAIN �� GAS FIREPLI�CE <br /> ' FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER � GF,S PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I — <br /> I HEREBV CERITIFY THAT I HAVE READ AND EXhMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND COfiRECT. ALL <br /> PROVISIONS OF L1WS�1ND ORIDINACES GOVERNING THIS NPE OF WOPK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PqESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEI THE PFOVISION OF ANY OTHER <br /> STAT[OR LOCAL LAVV REGUUITING CONF'RUCTION OR THE PERPORMANCE OF CONSTRUCTION. THAT I AM AUTHOR12ED BY THE <br /> OWNER OF TNIS PRGPERN TO PERFORM1I THE'NORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE 3TATE <br /> CONTRACTOFS LAW 1827 RGW P,ND 29fi.200 WAC. <br /> � 3 -�.� -oa <br /> .` / �c��✓ <br /> Sig ure c�Owner/Contract r ulhonzed Agent Date <br />