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i � <br /> P��RIVlfI" APPLICATIUf� <br /> CITY t�F EVERETT PERMIT SERVICES <br /> 3200 CEDAR S'fRE�T, EVEHETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS =-'�T c3 PARCEL TAX I.D.# ' P�1 IT s <br /> �c16 �leU✓hl_1C OL(J O O o I `J��� �(.�J <br /> LEG� LOT NO. BLOCK TRACT <br /> oesc. 3 - <br /> OWNEfl ADDRESS ZIP PHONE <br /> C��},�CL�!`�� /�ome$ 2�c_ 70 . doK ��aS t�t�n � l.vp S3rlo� <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR a�� �p AOORESS ZIP CONTR.LICENSEN <br /> Li �r.tt /k��S �,� . <br /> L!-FCGL N Z oo�j L. <br /> PfiONE N2S � 3S�-���"1 �o. 3ox 3�5 EV�-'�T`T W�+ 58ar3 <br /> PROPOSED USE OF BUILOING I B ilding MeChanlCal Addition HEAT SOURCE <br /> PERMIT �Cpmhination R Pl9mbing IWORK � Altsratian Eles«k <br /> TYPE � Demolition D Si n TYPE 'f�ow <br /> Sprinkler Repair/MainL O�her <br /> CONTRACT PRICE OF'NORK J�U K / /'� /� / � CITY OF EVEFEfT LOCAL SALES TAX CODE IS 3105 <br /> G �f <br /> WOqK DESCRIPTION <br /> CU�ST/Lv�s,o � vr EuJ ?.�oz 1�7 5F',2 <br /> PLUM8ING � �/�/ MFCHANICAL <br /> NO. TYPE OF FIXTUqE OR iTEM N0. TYPE OF FIXTURE OR ITEM <br /> 3 bVATEF CLOSET � � <br /> Z BATIiTUB aC–A/HANDLING UNITS <br /> -'f.� LAVATORY (WASH BASIN) I ��� —L FORCED AIR SYSTEMS <br /> / K SHOWER / _ HEAT PUMP <br /> I KITCHEN SINh 8 DISPOSAL — UNIT HEA7ERS <br /> � DISHWASHER _L CLOTHES DRYER <br /> — � RANGEHOOD <br /> LAUNDRY TRAY I WATER HEATER <br /> � CLOTHES WASHER METAL FIREP�ACE/STOVE <br /> _ URINAL FIREPLACE INSERT I <br /> _ DRINKING FOUNTAIN I Gq�FIREPLACE <br /> _ FLQOR DRAIN 3AS RANG[ <br /> _ 6ACKFLOW PREVENTER y� GAS PIPIRG � <br /> _ SINK(S[RVICEBAWMOPiETC.) � EXHAUST FAN -: <br /> _ OTHeR OTHER <br /> I <br /> i <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPUCATIOtJ AND KNOW THE SAtdE TO 6E TRUE 4ND COPPECT. ALL I <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL 6E COAIPLIED WITH WHETHER SPECIFIED HEREIN OR � <br /> NOT. THE GFANTING OF A PERWIT DOES NOT PRESUME TO GR'E AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHEF I <br /> STATE OR LOCAL LAW REGULATING CONSTAUCTION OR THE PERFOFMANCE OF CONSTRUCTION. THAT I Ald AUTHOPIZEO 3Y THE <br /> _ OWf:ER OF THIS PROPERTY TO PEP.FORM TNE WORK FOR 6VHICH APPIICAl10N IS MADE AND I COMPLY WITH 1�HF.STATE � <br /> CONTRACTORS lA'N 19.2 3CW-flND 296.200 AC. i <br /> C ti� A 2l� � <br /> SignaWre ol OwnedConlre r/Aut onzed Agent a1e� � <br /> ya � <br /> — � <br />