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�ERMIT APPLICAT�JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> S�II R� '�� � �� � !GS LJ�G���Z00 PERMIT x W� <br /> LEGA LOTNO. BLOCK TRACT� � <br /> DESC. <br /> OWNER ADORESS ZIP PHONE � <br /> �;U���.�� � ��Gu�-y as�/ �°�� Sr,l����r' �1 Zs�-��s4 ) <br /> TENANTNAME'�� I CONT����P�IT���� PHONE�-�c, <br /> �.�y <br /> � Gi i .r•�. z5Z -+C F� <br /> CONTRACTOR �C� ��O��S� ADDRESS r+c� _ _ �� ZIP CONTR.LICENSE N <br /> ��?s �, �9e �Ji ., p ��C�, <br /> PHONE 71I �S A'r `��� / <br /> C36C� 568-�`�75 �' ? MoG*0�3 �4 <br /> PROPOSED USE OF BUILDING Building � Mechanical � Addition H�OURCE <br /> O�� /�K ��?�,�� PERMIT � Combination Plumbing WORK Alteration Electric <br /> � TYPE Demolition Sign 7VPE New Gas <br /> Sprinkler RepaidMaint. Other <br /> CONTRACT PRICE OF WORK � (�QG•OC n /CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION 'r FIr/�l1�E —S EY K�/�y� • �'� PS <br /> 6iY1'i G�j.9�sL� L�iY�� ��i� � �AG.9��Gx/F��'•t�'lS��ciND <br /> �✓eas /v✓ � 5'. r.1�. <br /> PLUMBING N A MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM VO. TYPE OF flXTURE OR ITEM <br /> � WATER CLOSET C� A/C-A/HANDLING UNITS <br /> � BATHTUB S7 FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) SL HEAT PUMP <br /> SHOWER SJ_ UNIT HEATERS <br /> � KITCHEN SINK&DISPOSAL � CLOTHES DRYER <br /> (, DISHWASHER Q._ RANGE HOOD <br /> � LAUNDRY TRAY 'NATER HEATER <br /> � CLOTHES WASHER � METAL FIREPLACE/STOVE <br /> � URINAL Q FIREPLACE INSERT <br /> DRINKING FOUNTAIN � G.4S FIREPLACE <br /> � FLOOR DRAIN GAS RANGE <br /> UT BACKFI.OW PREVENTER � GAS PIPING <br /> � SINK(SERVICElBAR/MOP/ETC.) EXNAUST FAN <br /> � OTHER � OTHER <br /> II HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICAT�ON AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COM1iPLIEO WITH WHE7HER SPECIFIED HEREIN OR <br /> ' NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> iOWNER OF THIS P OPERTY TO PERFORM TH WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTO S W 18.27 W D 296.2 AC. <br /> Signaturn of OwnedConlractoUAuthorized Age ate � IIZi <br /> I <br /> i DEBI CREDIT CARDS ARE NOT ACCEPTED <br />