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�. � <br /> � - ' <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDHESS PARCEL TAX I.D.If P RMIT N <br /> a� -� �� ao58 90o G �+ r�-�vo <br /> LEGAL LOT Np. BLOCK TRACT <br /> DESC. f S ? I(o .3 S RDO i �O.•I TO .F. � T 3 <br /> OWNER ADDRESS PHONE <br /> �, � � .s atiy - � a� s •�/og5 <br /> TENANTNAME I CONTACTNAME PHONE <br /> �TRACT R ADDRESS CONTR.LICENSEN <br /> W. (dr.� Sr2kcrio� / / / / 02 IJit�No.J/. !I�-i� 3'Wco,��-l�l�a8/3i— <br /> pHONE oZS 33 - 7..SS�b 't'k ���//..r1S � W� SSasY <br /> PROPOSED USE OF BUILDINO Building Mechanical nddNbn HEAT SOURCE <br /> PERMIT Combinalion R Plumbing WORK Altaration n Eloctr�c <br /> TYPE Demolilion � Sign TYPE e�� D Gas <br /> ��� Sprinkler RepeiqMelm. �� D other <br /> CONTRACTPRICEOFWORK 3 �R,� C'Q CITYOFEVERETT:.00ALSALESTA7(COIDE139f05 <br /> WORK DESCRIPTION <br /> �R�-� � <br /> D�-��'L-- <br /> PLUMBING MECFiANI�l+L <br /> NO. TYPE OF FIXTURE OR REM NO. T�'�5 OF FlXTJFIF.OR�lE�f � <br /> 1 <br /> WATER CLOSET N'C—A/HANDLING JNIT3 I <br /> _ BATHTUB I _ FORCED AIR SYSI'EMS <br /> _ LAVATORY(WASH BASIN) HFA'I'PUMP <br /> = SHOWER I � UMTHEATERS <br /> KITCHEN SINK 8 DISPOSAI _ ;;�OTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY � _ NfA?EF1 HEA7ER <br /> CLOTHES WASHER _ l.1ETAL FIREPLAC�:�STOVE <br /> URINAL I _ _I FIREPLACE iNSERT <br /> DRINKING FOUNTAW _ GAs'FIREPLACF <br /> = FLOOR DRAIN �I CAS RANGE <br /> BACKFLOW PREVENTEH __ ^vAS PIPIhC <br /> SINK(SERVICE/BAR/MOP/El'C.) _ EXNAUS'f FP.N <br /> OTHER _ nTHFR_ <br /> I HEREBY CERITIFY THAT I HAVE READ,qND EXAMINF.O Tii!S APFLICATION AND KNOK'THE 3AME'(O BE YfiUE AMD CORRECT. ALI. <br /> PROVISIONS OF LAWa AND ORIDINACES GOVERNIN3 TH�S TYPE UF WORY.WILL HE COMPLiED WITH WHETHER SPECIFIED HEPEIN OR <br /> NOT. THE GRANTING OF A PERM�T DOES NGl'PRESUME?[+GIVE AUTHOqITY TO VIOLATE OR CANCEL THE PROVISIqN OF ANY'OTHER <br /> - STATE OR LOCAL LAW rIEGULATING CONSTRUCTIOi�OR THE PEH'hOR�dhYCE OF CONSTRUCTIOk. THAT 1 AM AUYHORIZEU BY TI1E <br /> OWNEti OF THIS PFOPERTY TO FERF07M THE WnRY.FOft WNICh APPUCATION IS MAUE ANC I COMPLY W�7H TNE STATE <br /> CONT ORS LAW 18.27 RCW AND 29620P WAC. <br /> (S^G�� �9� !0" Fl '� I <br /> Siyn ture of OwnedContractoNA rired Hgent --5t ato <br /> ----�.—� — /�3. 3% �]i <br />