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i <br /> 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 TAX I.D.A PERMIT M <br /> z � 1► �tr �zsa�' <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER f4,L,/�ft •(IG/C f'<<f/I/f/�'S /A1DDRESS �1 /JLGP PHON`E <br /> /�N`/ �.y�} `U/Gj�//V� �ZL'Jr C L•� 73Z�yI /1�J'2S7'7C�CJI <br /> f <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR �C� GDS�f q�IC�iI ADDRESS , . ZIP CONTR.UCENSE• <br /> S�'rvtcc s �nc.. 154G1�5'S� 37"t,'p.5�/� S�°20D ('�+ ,/ .0 /1p� <br /> PHONE 'T�S' ��T �ODLG ��1 �C��i i.l '`� 70C�DlC-' IZ � ` -C/V l (.� /7 NIU <br /> PROPOSED USE OF BUILDING BUilding D MeChOniCal Additlon MEAT SOURCE <br /> PERMIT R Combination B Plumbing WORK R Alteralion n Etectric <br /> TYPE � Demolition Sign TYPE ❑ New ❑ Gea <br /> Spnnkier C� RepetnMalnt. D Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCPIPTION , <br /> �.�-���1���1� R��� 1����,j <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR fTEM NO. TYPE OF Fl)fTURE OR ITEM <br /> _ WATERCLOSET _ A/C—A/HANDIINGUNITS <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 /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> i _ BACKFLOW PfiEVENTER _ GAS PIPING <br /> _ SINK(SERVICElBAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> � I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> �, PROVISIONS OF WWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEiHER SPECIFIED HEREIN OR <br /> � NOT. THE GRANTING OF A PERMIT DOES NOT PpESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUTATING Cc�NSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEATY TO PERFOhi.'.THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOFS LAW 18.27 RCW AND 296.2U0 WAC. <br /> Signature of OwneUConlractoUAuthorized Agent ate �,� <br /> J <br />