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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 fi� <br /> 0 0 3 6 ov a �JZ-O�Z <br /> LE6A LOT N0. BLOCK TqACT <br /> DESC. <br /> OWNER ADDRE88 P VMOIiE <br /> �7 I f� /V/}�i �.� •,� /041iQ /1�4✓ �i�vP�" �2S .L.S 1 S'[ [�l <br /> TEIMNT NAME �� I�CONTA W1AAE pHONE <br /> �a✓/� i /oo/HP�. �.�i NGr �•. �� / 2S� .ZS 2 SZ (o Z <br /> CO;�ACTOR ADOR688 aP CONTR.LICENSE• <br /> /Vo�'ht�oas� t��� �e� 30�� s. l.�n C�6w�I�Ad� N��V/� QSb71 /11a0.YHivtl��Uy <br /> PMONE <br /> _ol7.r <br /> PROPOSED USE OF SUILqNO . ' � 8uliding Mechenical Addidon HEAT 80URCE <br /> PERMR Combinetbn � Plumbing WORK B Alteretion � Eiectric <br /> 7YPE Demolllion Sign TYPE D N�w Oes <br /> Sprinklar U RepsirMleinl. pu�r <br /> CONTRACT PRICE OF WORK /l/� � CITY OF EVERETT LOCALlALEB TAX CODE 18�106 <br /> L.7 <br /> WOR DESCRIPTION I � <br /> S�i.s -�'p� �nC f fnt� �x . <br /> PLUMBING 61ECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM N0. TYPE OF FlIITURE OR 1?EM <br /> _ WATER CLOSET _ A/C—AMANDLIN�UNtTS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHUWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANOE HOOD <br /> _ UIUNDRY TRAY _ WATER HEATER <br /> _ CLO7HES WASHEF _ METAL FIREPUICE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ f3AS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANOE <br /> _ BACKFLOW PREVENTER _ pAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH NMETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME PROVISION OF ANY OTHER <br /> STATF OR LOCAL lAW i7EGUlATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNE R JF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH iHE STATE <br /> CONTR I+RS LAW 18.27 RCW AND 296200 WAC. <br /> ���.0 �'/�.v O <br /> SRlnBW�e oi OwneU onlracroq onzed Agent ete <br /> �-. <br />