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( ( <br /> PERMIT APPLI�ATION <br /> CITY OF EVERETT PEPMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> �l� 425-257-8810-FAX 425-257-8857 ��_ <br /> SITE ADDRESS PARCEL TAX I.D.N P MIT• <br /> X Ee�s oR Cv�i w oos 4 i - o o� _ o�,s- �� 0 7- /�- <br /> LEGA LOT N0. BL CK TRAC <br /> DESC. C � �� � - �� � �C� <br /> OVYIIER ADDRE9S LP PMONE <br /> l2�(S�L I'I'1>M�S �LC 2'x�6 II`1f'� St- Svu EJE��, vdn `182oy <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Mfl�-�o �IIAs yz5-- z�� -S�5� <br /> C TRACTOR AUDRESS ZIP CONTR UCENSEt <br /> �- l+oM E5 L�c. S��- as a�,�e �-zY�t-c.ri-t. 9'���•l <br /> PMONE L.IZl7��Z ' I��� `�� � U�J <br /> PROPOSED USE OF BUILDINO TMPErt e Dem kR o,non R S 9mD ng ' WO EK R/��entlon „�DT s'ENcMc <br /> Y f S i C�f�ti� d U R,Pao-rteamt. U omx <br /> CONTRACT PWCE OF WORK . I I£O'!1 J�11 CITY OF EVERETT LOCAL 9ALE3 TAl(CODE 19]706 <br /> v l/uU <br /> WORK DESCRIPTION <br /> re��de�wQ dkpi�c /�/�3 � " � <br /> y 9a �� <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET � A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAV.�TORY(WASH BASIN) � HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL � CLOTHES DRYER <br /> ,� DISHWASHER L RANGE HOOD <br /> � LnUtlDRYTRAY ,�, WATERHEATER <br /> CLOTHES WASHER � METAL FIREPLACEISTOVE <br /> URINAI. � FIREPLACE INSERT <br /> DRINKING FOUNTAIN � GAS FIREPLACE <br /> � FLOOR DRAIN �,, GAS RANGE <br /> ,Q BACKFLOW PREVENTER GAS PIPING <br /> � SINK(SERVICE/BAR/MOP/ETC.) � EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERIT�FY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH NMETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANfING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CO TRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPER PERFO THE WORK FOR VNiICH APPLICATION IS MADE AND 1 COMPLY IMTH THE STATE <br /> CON C R LAW 18.2 W AND .200 WAC.� <br /> r � <br /> Sign ur of er ontrector/Au on:e gent . a <br /> DEBIT& �REDIT CARDS ARE NOT ACCEPTED S� b�O `��� 7 U <br />