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P�RMIT APPLICATIEyN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA �J8201 <br /> 425-257-8810-FAX 425-257-8857 <br /> SITE ADDRE S . PARCEL TAX I.D.N pERMR• <br /> 2��� - ool ol - l <br /> lEOA l0T N0. BLOCK TRACT <br /> DESC. <br /> OWNERCC.✓C/a?t� ,UG/G `LfCII�f�t'S ADDRE83 a PHONE <br /> v��t �Y25 ��/Grflve �1i-a'" f�•f 9�Zv/ fz.�"�s�-�aoi <br /> TENANT, `NE I CONTACTNAME PHONE <br /> CONTRACTOR ��� Cans�ruc�1D71 AGDRESS . . nP CONTR.UCENBc� <br /> Si'rvtc� s �n� 15�4"05'SF. 37t"•5� •S�e200 <br /> PXONE �7t�( )e�ue. 980D/o FY1L:��.�5�0`l9 Nlv <br /> 4Z5= 4S4 -ffOZfi <br /> PROPOSEDUSEOFBUILqNO fl Building D Mechanical f1 AdAltbn MEATSOURCE <br /> PERMIT K Combl�el(on u Plumbing WORK K Nteratbn I7 EbcMc <br /> 7YPE �� Demolitlon U Sign TYPE �_� New R p�e <br /> U Sprinkler LJ RepelNMeint. LJ Other <br /> CONTRACT PRICE OF WORK CT'OF EVERETT LOCAL SALES TAX CODE IS�106 <br /> WORK DESCRIPTION , <br /> ����-�,�5�� Ru� ����,j . <br /> PLUh1BING MECHANICAL <br /> NO. TYPE OF FlXTURE OR lTEM NO. TYPE OF FlI(TURE OR ITEM <br /> _ WATER CI.OSET _ A/C—A/HANDLINO UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATEFS <br /> _ KITCHEN SINK 8 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 _ f3AS FIREPLACE <br /> _ FlOOR DRAIN _ (3AS R;+��OE <br /> _ BACKFLOW PREVENTER _ GAS PIi�ING <br /> _ SINK(SERVICE/BAWMOPlETC.) _ EXHAUST FAN <br /> _ OTHER OTHER <br /> I HEREBY CEFiITIFY THAT I HAVE REAC AND EXAMINED THIS APPIICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND OAIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTiNG OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL47E OR CANCEL THE PROVISION OF ANY OTHEfl <br /> STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED B'!THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH TFiE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> Signature ot Owner/ anttactodAulho�ized Agent e�e ��,�'J✓ <br />