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P�,�MIT APPLICATIG . J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 <br /> b �-�S -p 2 <br /> SITE ADD�SS PARCEL TAX I.D.# � §r1MiT a <br /> ,' o I RA�� oo �.�� '�'s vo �' o f; I �2D� -.�JZ/ <br /> LEGA LOT N0. B OCK TRACT <br /> DESC. ,,.c� L! I!J i'�.3 � !]�OS <br /> OWNER AD�RESS ZIP PNON[: <br /> �✓,��Eti ivte���`5 �- �6�.s �,7,�Il,el,v l� l� ��� .-�r. y Zui 2Sy' -10070 <br /> TENANT NAME I CONTACT NAME PHONE <br /> CONTRACTOR A'.7DRESS ZIP CONTR.LICENSE R <br /> (�ai✓ SLycic �55�� ��1�Pc � i.vC . l�o Bok /304- 6 '/�u2,�� <br /> PHONE V/�NS C�I OZ/DD <br /> �/L 5 - ? 0 3• �YcS� <br /> PROPOSED USE OF BWLDING Building f'� Mechanica� Adtlition HttAT SOURCE <br /> 5 IE FG�.-.��7 ri n D.+, PERMIT � Combinalion K Plumbing WOHK �Alceration �Electric <br /> TYPE Demolilion LI Sign TYPE New Gas <br /> Sprinkler RepairRdainL I , Other OI / <br /> CONTRACT PRICE OF WORK �i /- Q �J� ,J o CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> lN <br /> WORK DESCRIPTION / <br /> � C�l- %'ai..-..�L �C�CM . <br /> ,�,-e,...� r<<,�. �,<<�.�, �.. , <br /> PLUMBING MECHFNICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> X WATER CLOSET A/C-A/HANDLING UNI�S <br /> BATHTUB FOACED AIR SYSTEMS <br /> � LAVATORY�WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> �' KITCHEN SIN'<8 DISPOSAL CLOTHES DRYER <br /> ��' DISHWASHEh /� RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACElSTOVE <br /> URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE � /� <br /> FLOOR DRAIN / 'GAS RANGE "'�� <br /> BACKF�OW PREVENTER 7� GAS PIPING <br /> � SINK (SERVICE/BAR/MOP.�[TC.) _ EXHAUST F�N <br /> _ OTHER �(_ OTHER�' <br /> _ _ d7 /�✓u �i+ �n <br /> I /=L�4:�2 /�GA� ,j�/'s'..� <br /> — �A�.�ST.nL �J.• .���L <br /> i <br /> ' I HEFEBY CERITIFY THAT I HAVE RE4D AND EXAMINED THIS APPLICATION AN�KNOW THE SAtdE TO BE TRUE AND CORRECT. ALL <br /> �, PFOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WOFK WILL 6E COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GFANTING OF A PEFMIT DOES NOT PRESUh1E TO GIVE.4UTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> i STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> i OWNER OF'fH1�OPEATY TO PEFFON(1 THE}yOFK FOR WHICH APPLICATION�S MADE AND I COMPLY WITH THE STATE <br /> I GONTRACTCRSIAW 1827 RCW aNU�29620D�WdC. <br /> - ;' � /�'`��!%� <br /> `�( Cn"U Z� ' <br /> ; i. , <br /> Signoture ot OwnedContractoUAulhorized Agent Date / <br /> I � <br /> I <br />