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i <br /> F��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.N PERMIT x <br /> _ � <br /> LEGA LOTNO. BLOCK TtiACT <br /> DESC. <br /> OWNEH ADDRESS aP PHONE <br /> ,�A,vc i t/�� 1�.�o r ��� G�/+N.� r`�zol �5'Z� ZSZ- 37 Z <br /> TENANT NAME I CONTACT NAME PHONE <br /> ��� _/ ��7-��i�3� <br /> a � <br /> �p�Mp��p�_ J r � ADDRESS DP CONTR.llCENSE 1 <br /> J LpRr� / Z -�/ Z5� � ��� 1�3 � ZC9� �/�h� <br /> PHONE� _�y /�/�D <br /> /J � 7p`;' <br /> PROPOSED USE OF BUILDING � Building � MBChAn�cel Addition H URCE <br /> PERMIT COmhineti0n PlUmbing WORK � Alteralion n Eieclric <br /> TYPE Demolition Sign IYPE New ❑ Gaa <br /> Sprinkler RepaidMaint. � Other <br /> CONTRACT PRICE OF WORK � C(TY OF EVERETT LOCAL SALES TA%CODE IS�705 <br /> WORK DESCRIPTION <br /> ,(�E,�oDr - �rC� o� STEp�Gf�NG/°'�C+ <br /> PLUMBING MECHANICAL <br /> ryp, TYpE OF FlXTURE OR fTEM NO. TYPE OF Fl7fTURE OR ITEM � <br /> WATER CLOSET _ A/C—AlHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWEF _ UNITHEATERS <br /> I KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNORY TRAY WATER HEATER <br /> I = CLOTHES WASHER = METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN (iAS FIREPLACE <br /> I FLOOR DRAIN GAS FANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERV�CE/8AR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ _ OTHER <br /> 1 HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPL�CATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF lAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GFANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PEFFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> � CONTRACTORS LA 18.27 RC�A,�AC. <br /> �'p�i f3�DL <br /> � <br /> SignaWre of OwneqCo racrodAuthonzed Agent � Se � <br /> �i <br />