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P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TN(I.D.� PERMIT# <br /> iG- n f/Ec���rr ��� oo�i��l�'a.��ood 401 -0_� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS ZIP PNONE yZ��T�IS y��� <br /> Rcy rti%����t.�i Th �t � - • �o�z <br /> Kcn Oe r9n r7"ii.�� /G.r�'D�/ 7 /-2v� 5,E /D / /7/�/%ir�� <br /> TENANTNAME CONTACTFORPERMR PHONE <br /> -S�t_��✓�-�/ �:i��ow,« !lt�� �Ho� s �r2s`- ��D -��� <br /> CONTRACTOR ADDRESS 21P CON7R.LICENSE M <br /> oi/CiliL if'c�.l rNTil�iO/�� iN[, /?i/S-n-i[/(i/tc ��EEi)et�J'W �C..L��Df1.1�� <br /> PHONE �%�/)/� 1 it.i ft Li <br /> dZ5"-�r �'>05 ! V/vi�,:.iooa , Gv/T 9�a3`i <br /> PROPOSED USE OF BUILDING �Building �Mechanical �Addltlon HEAT SOURCE <br /> PERNIIT Combination Plumbfng WORK PJteratlon D��� <br /> 7YPE DemaliUon Sign TYPE New ����s <br /> Sprinkler RepaidMatnt. � OMar <br /> CONTRACT PRICE OF WORK Jf����� CITY OF EVERETT LOCAL SALES TA%CODE 19 7705 <br /> WORKDESCRIPTION �y�J��� ��U/?-/� li'7Y'2dVl=/Y1UVl� ?D i.vcLu/7G° DEmO/�iGN D� <br /> ��CT(� GAa -L' u/O/J./L - G��v���t<_Sr N<�U //I!f'U'02 Ndn/ .��/Z!/LiU/iLG Q1317�1/�'iDrik�, 2E�1� <br /> /t�cT,/ /�//7.0 /an9/�L�.�i�n- ��•r ,1o�n�. /Jnoi1 , i�l��r�z��cui���F_ , F�iv/�Nc� dND <br /> /lU_;Ti7-LCY�-t iu�J OF /::�-.7rJu/'.�-,Jl :=d u� Pi�i_it>l, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FO(TURE OR ITEM NO. TYPE OF FlX7URE OR ITEM <br /> � WATER CLOSET(TOILET) _ A/C-AIHANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> �, �, LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER \_ UNITHEATERS <br /> KITCHEN SINK&DISPOSAL CLOTHES DFfYER <br /> — � RANGE y00D <br /> DISHWASHER <br /> LAUNDRY TRAY `\ WATER�4iEATER <br /> CLOTHES WASHER _ rAETAL�FIREPLACE/STOVE <br /> URINAL _ F PLACE INSERT <br /> DRINKING FOUNTAIN _ G FIREPLACE <br /> � FLOORBRMN��iKK _ AS NGE <br /> � BACKFLOW PREVENTER GAS P ING <br /> � SINK(SERVICEIBARIMOP/ETC.) EXHAUS FAN <br /> OTHER � � OTHER <br /> y ,�f�. ,,� <br /> � ;_.c��:.,>.���i���,�-,�,c�, — <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANU CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WFIETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO G�VF.AUTHORITY TO VIOLATE OR CANCEL TH[PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PEHFORMANCE OF CONSTRUCTION. THAT I AM AUTMORIZED BY THE <br /> OW NER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPIICATION IS MADE AND I COMPLY W ITH THE STATE <br /> CONTRACTORS LAN'18.27 RCW AND 296200 WAC. <br /> /,� l�� .�/ '�^��o�- �; \ <br /> Signature of Owner ontractor/Authonzed Agent 1� 1 <br /> L/ <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />