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P�RMIT APPLICATI <br /> CITY OF EVERETf PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADD�ESS . PARCEL TAX LD•R^/ �C n PE^ __C W V <br /> L (� �G' I�G1 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER L.y�LIC%Ct •Ll�J/L /�'«ClI/f/t'S ADORESS � aP PHONE <br /> � / C' 1�-2Jr7-70L / <br /> ,C�/Sf pyZ7 �v/G��VC' �'24".5� �i.•f' 9�Z '/ � � <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR �C L �G��'}r���V i1 ADDRESS , , LP CONTR.UCENSE• <br /> Stvv'�cc= s �n L IS4C�S 5�. 37"/�'p•5� S�i°2C� f'.�:LC.C'.�5 i 099 Nlv <br /> PHONE �Z`J ' �`,'4 ��`�LC-� �IIE'-Vi,le. 7JL�L?� <br /> PROPOSED USE OF BUILDING Building � Mechanical Additlon HEAT SOURCE <br /> PERMI7 � Combination Plumbing WORK Atleratlon � Electric <br /> TYPE Demolition Sign TYPE New Gaa <br /> Sprink�er RepeirlMaint. Othar <br /> CONTRACT PRICE OF WORK CITV OF EVERETT LOCAL SALES TA%CODE IS J106 <br /> WORK DESCRIPTON . <br /> �����1� �i� R��� ���.�,�j <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. IYPE OF FlXTURE OR fTEM <br /> _ WATER CLOSET A/C—A/HANDLIN�UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINA� FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANQE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER OTHER <br /> �HEREBY CERITIFY THAT I HAVE tiEAD AND E%AMINED THIS APPLICATION AN�KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L4W5 AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIfIED HEREIN OR <br /> NOT. THE GtiANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OP CANCEL THE PROVISION OF ANY OTMER <br /> STATE OR LOCAL V+W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM TNE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> Rignatore of OwneUContractor/Aulhonzed Agent ate \����/�/V � <br /> �X��/ <br />