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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 TAX I.D.1 pEpMR� <br /> � � �G ; Daao - <br /> LEOA L07 N0. BLOCK TRACT <br /> DESC. <br /> OWNERE��Ci�t -l�b/G ��`r�i/�f.r5 ADDREfB <br /> ` v v G 9�1� / f1�,f57-7Gb/ <br /> ��J 1y2s � Grf� e �`2Gs f�- � <br /> TENANTNAME I CONTACTNAME pMp� <br /> CONTRACTOR �L'c. Ul1��IT 61 C�'1 C9 n ADDRE88 . . nP CONTA.LiCENtE 1 <br /> Se'rv�cc� �; �nL 15'"4"C�5'S� 37'"pS�/� S�e2C� [y�� � � p pp <br /> PMONE �:7E'_I IP�i.1G 9JG�L�!<•' f(..LLC�.S.L � �7 NW <br /> 42.9= 454 ��02C,� <br /> PROPOSED USE OF BUILOINf3 Building MechaniCal Ad0ltlon MEAT WUIICE <br /> PERMIT B Combtnation � Plumbing WORK B Alunlbn n p� <br /> TYPE D Demolitlon Sign TYpE D N�v, ❑ p�, <br /> U Sprinklor U RepNdMekH. � OMNr <br /> CONTRACT PRICE OF WORK qTY OF EVEOER LOCAL SALE!TAX COOE 1{010i <br /> WORK DESCRIPTION <br /> �����i���1� R�� ld��,j <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM NO. TYPE OF RXTURE OR ITEM <br /> _ WATER CLOSET _ NC—A/HANDLINQ UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) ,_ HEAT PUMP <br /> _ SHOWER _ UNITHEATERS <br /> _ KITCHEN SINK S DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANOE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> _ CIOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ �RINKING FOUNTAIN _ �AS FIREPLACE <br /> _ FLOOR DRAIN _ QAS RANOE <br /> _ BACKFLOW PREVEN7ER _ �AS PIPIN6 <br /> _ SINK(SERVICElBAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I I HEREBY CERITIFY THAT I HAVE READ AND EXAMI"ED THIS APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNi�JG THIS NPE OF WORK WILL BE COMPLIED WITH NMETHER SPECIFIED MEREIN ON <br /> � NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CON�TRUCTION. THqT I AM AUT};JRIZED BV TME <br /> OWNER OF THIS PROPERTY TO PERFORM TF1E WOHK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> � ��✓ ; <br /> Signature of Owner/Contractor/Authorixed Agent ats <br />