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!` <br /> , <br /> PERMI�' APPLICATION <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 x <br /> Z2o�3 �asf C�r��d �70377y`l �`l02 `GOO M011a.-(7D5 <br /> LEGA LOT NO. BLOCK TRACT <br /> oesc. zg _ zq Y��j /Fl+qn ..,� qdd�r�� -lv Nbl�' Z <br />�. OWNER ADDRESS ZIP PHONE <br /> �lthn �n1oti'cs E.�'�;�,s�.. 2tu�, E.�r� G�c./ ��t2t► � 9gLl �`!�-S� 2t'3-/>�43 <br /> TENANTNAME I CONTACTNAME � PHONE <br /> �4h. ��.��u, t'�t,'l �:s-�;,g <br /> CONTRACTOR /J ADDRESS DP CONTR.LICENSEN <br /> �4, IA�� r�h'4�ti� V.4-�iry'/JLi , c�.��Ma���'� �+sWG IM1'n'2Ii/ °9yc., <br /> Uts' ))f-GYGY rin�l�. L'1/t/L01-, hl� y97.u1 ��1v[`S�0\'UNS <br /> PMONE Ot�i� D+tiMi/q9�.. 1!I� h y <br /> 4�.:- :,� - HL tl <br /> PROPOSED USE OF BUILDING � Building Mechenical n Addition MEAT SOURCE <br /> PERMIT COmbineliOn � PlUmbing WORK � Alteralion � Eleclric <br /> TYPE Demolition Sign TYPE New Gas <br /> Sprinkle� RepairlMaint. Other <br />, CONTRACT PRICE OF WORK I o{cI v yyQa CITY OF EVERETT LOCAL SAIES TAX CO�E IS 3105 <br /> WORK DESCRIPTON I , ,/� <br /> �� QP/Ikt Cu«r 1' [/<�r:c �f.�l- r,.cfv� �.� �,.,r� 9�s /�ol- l..cft� '�<.K �/ 4N�1'✓�( v�.,r/ <br /> 2. �'a1f.� '�a� C�c./ t/U'Lt S�urt 1 � �:�:�.� �OJ� . � I 0..•F �7.�.� V(•.f ) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIMURE OR ITEM NO. TYPE OF FlXTURE OR REM <br /> WATERCLOSET _ A/C-AIHANDLINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <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 INSER <br /> DRINKING FOUNTAIN Z GAS FIREPLACE �r�� Sk,y(i a �1q�,, <br /> FLOOR D�AIN _ GAS RAfVGE <br /> BACKFLOoJ PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> � K,� ����) — <br /> 1 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br /> PROVISIONS OF LAWS 4ND ORIDINACES GOVERNING iHIS TYPE OF WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEFEIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUfAE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PEflFORM THE WORK FOR WHICH APPLICATION IS MALE AND 1 COMPLY WITH THE STATE <br /> CONTRACTORS LAW 78.27 RCW AND 296200 WAC. � <br /> .(�'�.� �h- /z/�/�,� � Id - ��J <br /> Signa�wnedContraclodAuthonzed Agent ale <br />