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i <br /> P�:RMIT APPLICATI(f.�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> Z"�"` � �� PARCEL TAX I.D.8 � PERMI7 k <br /> SITE ADDRESS 4��� � �a.O�-{?D� <br /> $ '{��. �C's 1�. � S -oov -�o _o G <br /> LEGA LOT NO. v��BLyOC�: �V TRACT � _ <br /> �ESC. ��' ��1�¢ � � bp pNONE <br /> OWNER ADDRESS y2L D2 �/`� <br /> �' . CAn�su.v a32S GRRwcI A✓P'�S� �b�-2vl 379-5/�'7 <br /> 11 .e ..�e1iC PHqyE2- 206I � <br /> TENANTNAME CONTACTNAME y L <br /> S I� eNN �s � z�a�w 3�-s"��-7 <br /> „� ADDRESS 2 3 ZS �Vi /�t�'y nP COMR.UCENSE N <br /> CONT ACTOR"D�rtiiS . C•�2�Su 9 �,zv � . <br /> TCNN�cc/Sy f� <br /> PHONE Y2S• S"-L- 2U �/ Cs�( <br /> `/e2� 34 -5% Addition HEATSOURCE <br /> Building Mechanical <br /> PROPOSED USE OF BUILDING Eleclric <br /> ' le . ^�`�-P��XS PERMIT COfnbi08li0� Plurt�bi0g WORK Alterallan � Ges <br /> 'I�w J-��� TYpE Deinolition Sign IYPE New <br /> Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION n n � �} bu ,� o- ��� ��''R'� <br /> ���.,,� O GJODG� S �C'c.cS SX/`'`SejR- ' ` ' �}t <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fll(TURE OR REM <br /> NO. TYPE OF flXTURE OR ITEM <br /> WATER CLOSET _ A/C-A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> UNIT HEATERS <br /> I = SHOWER _ CLOTHES DRYER <br /> KITCHEN SI�1K 8 DISPOSAL RANGE HOOD <br /> I = DISHWASHER _ WATER HEATER <br /> �AUNORY TRAY METAL FIREPLACE/STOVE <br /> i __ CLOTHES 1NASHER FIREPLACE INSERT <br /> URINAL GAS FIfiEPLACE <br /> I _ pRINKING FOUNTAIN GAS RANGE <br /> _ FLOOR DRAIN GAS PIPING <br /> BACKFLOW PREVENTER EXHAUST FAN <br /> �, SINK (SER1'ICE/BAR/MOP/ETC.) — pTHER <br /> OTHER — <br /> I _ _ — <br /> � I HEREBY CERITIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> I� NOTVITHE GRAN NG OF A ERMIT DOE 5 NOT PRE UME TO GPVE AUTFiORITY TO VIOL4 ELOR CA'NCEL T EHPROVIS OINI OF ANYEOTHER <br /> �� STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPEHTY TO PERFORM THE WORK FOR WHICH APPLIC.ITION IS MADE AND I COMPLY WITH THE STAT� <br /> � CONTRACTOPS LAW 1827 RCW AND 296.200 WAC. <br /> ��� ,�, �'► ('�� 5r�-2('�0� .� -0 <br /> vate <br /> ignature ol OwnerlConiractor/Authorized Agent �/ � <br />