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PE�MIT APPLICATIO�V' <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT# <br /> I � o ue���. v�i�u � ao ►�:o4d a-oo <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS iPHONE <br /> Cr�iu Slciov Il'12�t3Qeme�� Q.u (3c,� ��`�8i� �x'aNle 1,�� �I �I�a ! <br /> TENA NAME CONTACTNAME PHONE <br /> ���I��aU �� I I ��eh5ac� � 2oU �04 �i�b <br /> CONTRACTOR lllll�� � S��l'�S ADDRESS CONTR.LICENSE N <br /> ��}ou Cv�rc� r�e�, W2 4.<< u Nz it�S l�b R� <br /> y ( � t� A <br /> PHONE ��-S ��U �iV� � Cv�,re-� G� �7 <br /> PROPOSED USE OF BUILDING � Building � Mechanical Addition HEA�}T OURCE <br /> PERMIT � Combination Plumbing WORK B Alteration �¢ Electric <br /> TYPE Demolition Sign TYpE D New D Gas <br /> Sprinkler � Rapair/Meint. D OMer <br /> CONTRACT PRICE OF WORK ` , 4(��, CITY OF EVERER LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION 1`��.��� l � a�� ,1ew C�UI���c' �'1I SpI �Ti `���1� <br /> �`��C u i� �t 2 n c� -Ew o ek h�u S�t f2v�s��c,U i� ��S a C i 2't�� <br /> (� Ct � l �(i �u S'r� i!i' �'��'1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TUNE OR ITEM NO. TYPE OF FlXTURE 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&DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DFINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfFiER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHO(iITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OF LOCAL LAW REGULATING CONSTFUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFOqM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296200 WAC. <br /> ��;G' � �.��1� � -� � b� <br /> Signalure of Owner/Contractor/Authonzed Agent Date <br />