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P�RMIT APPL.ICATI�N <br /> CITY OF EVER�TT PERMI�T SERVICES <br /> 3200 CEDAR STREET, EVERETT, VJA 98201 <br /> 425-257-0810 — FAX 425-257-8857 <br /> SITE ADDRESS �'O r Z PARCEL TAX I.D.# ' PERMIT x <br /> / I�Qo E� 3ozk oS a33 aa � CO'��3 "G-�`{ <br /> LEGAL LOT N0. BLOCK TRACT <br /> oES�. Z /2vZ—� Z — <br /> OWNER A�DRESS 2IP PI�ONE <br /> Li4�EL✓�h10 /,4�y�: S Ti�c. ?v. 6ox 3�s c��.�c.�,tila �r�r�s" <br /> TENANTNAME CONTACTNAME PHONE <br /> CONTRACTOR 4wKtLN`�D N�l'h�s �T7c A�DRESS ZIP CONTfl.LICENSE N <br /> PHONE LrZJ�, J,S(�-^7J(u'7 �� �MIOS L/1KEc-NZOoI�jL <br /> � `�i��3 <br /> PROPOSED USE OP BUILDING Buildi g � DAechanical Addition HEAT SOURCE <br /> PERMIT ombinalion Plumbing WORK Alteralion Ele ' <br /> TYPE Demolition Sign TYPE ew as <br /> Sprinkler Fapair/Mainl. Other <br /> CONTRACT PHICE OF WORK ��O, AUU CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WOHK DESCRIPTIOtJ <br /> Cbi'�ST,c'-JGTIo � Ol' f�/CIIJ Zo`d�o SF'2 <br /> .,�/A�JG 20�-5(�l.uL���q� <br /> PLUMBING ML"CHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � WATER CLOSET A/L'-A/HANDLING UNITS <br /> !� BATHI'U8 � FORCED AIR SYSTEMS <br /> LAVATORY jWASFI BASIN) _ HEAT PUMP <br /> ;�_ SHOWER UNIT H�ATERS <br /> � KITCHEN SINK & DISPOSAL y CLOTHES DRYER <br /> � GISHWASHER _L RANGE HOOD <br /> LAUNDRYTRAY �_ WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINI<ING FOUNTAIN 1_ GAS FIREPLACE <br /> fLOOFl DRAIN GAS RANGE <br /> _ BACKrLOW PREVENTER -`�� GAS PIPING <br /> S'INK(SERVICC/@AR/MOP/ETC.) EXHAUST FA!J <br /> OTHER OiHER <br /> I fiEREBY CERITIFY TNAT I HAVE RC-AD AND FXAM1IINED TH�S APPLICATION AND KI�OV/THE SAME TO BE TRUL AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE l7F WORK WILL BE COh1PLIED WITH WtIEfHER SPEC�FIED HEREIN OR <br /> NOT. TNE GR�NTING OF A PER1�11T DOES NOT PRESUME TU GIVE AUTHORITY TU VIOLA'iE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFOFMANCE OF CONSTRIICTION. THAT I AM AUTHO(iIZED BY THE <br /> OWNER OF FHIS PROPERN TO PERFORAI THE WORK FOR WHICH APPLICATION IS MAGE AND I COMPLY WITH THE STATE <br /> CONTRACTORS L1N'18.27 FCW AND 2 200 WAC. <br /> . S�� I � .Y�?"I/4 7_ �/ <br /> SignaWre ol 0���.neq�or1lractor/Authon t D te � <br />