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P�RMIT APPLICATI(� .� <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.M P pMIT M <br /> �y2� oAr�s A��� y�syz�9oiv0007 �o�� G-C��( <br /> LEGA LOTNO. BLOCK TRACT `-/ ` <br /> DESC. II �' IU -J /L%D✓� ZN� .�� T� (iV �Qlf.� <br /> OWNER ADDRESS ZIp PHONE <br /> 1�Rv�a � KRR,£�4 tZuL�+�11C�� ��(ZI �AK6� A�� 46Zo1 4z� 139 bla � <br /> TENANTNAME I CONTACTNAME PHONE <br /> l�lont �Av►4 ALA1z�Alr�� yGy Z� l3l1 <br /> CONTRACTOR ��C,r�C C:A1'G��ADORESS 2-�-L�O 2JC,{/��r A�� LP CONTR.LICENSEM <br /> Qstor 1A��vrosaz,� <br /> PHONE 1{Z` �.-� '.z/1 <br /> PROPOSED USE OF BUIL�ING Building Mechanical Addilion MEAT SOURCE <br /> 5�l� �.�/�,�N�� PERMIT Combinalion R Plumbiny WORK g Alteration (7 Electric <br /> (rRrw t NPE Demolitian � Sign TYPE C]'NaW D ceg <br /> g Sprinkler U Repair/Maint. DfJMer <br /> CONTRACT PRICE OF WORK ����— CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> WORK DESCRIPTION <br /> SfrR PE�f�c.t.�IC i� G'.4!'o.�L DJ� JN o na l..T 1-1� � <br /> PLUMBING ^ MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N 1� NO. TYPE OF FlXTURE OR fTEM 'hI�' <br /> WATER CLOSET _ A/C-A/HANDLING UNITS <br /> � _ BATHTUB _ FORCED AIR SYSTEMS <br /> � _ LAVATORY(WASH BASIN) HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> I _ OISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY __ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPIACE INSERT <br /> I _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRA!N GAS FANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> S�lJK(SERVICE/BAR/MOPIETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFY 7HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KP�OW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L1WS ANO ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOUITE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOA WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOPS LAW 18.27 RC6V AND 296.200 WAC. <br /> Signature of Owner/ConiractodAuthorized Agent ate �� <br />