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P�RMIT APPLICATI N <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.N PERMR M <br /> `23 C�l 3 00/ Dczci3 - G3 <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER f.���/`Ct ��7�1 /C `�IC'llif/t'S A�ORESS ZIP PHONE <br /> C 1 -7 / ��/1 �/ s /JG <br /> .L7/�r G,yG�7 �V/LJj�//l1� a�L�'.�r Cl'� 7J���� '�l�'2J�7'7�� <br /> ! <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR �C� CCiOSFf q(� 1G�il ADDRESS LP CONTR.LICENSE N <br /> S�'�vlcr� •� �nL l54C5'S�. 37r"pS�/� S�'�''� (,+� � .0 /1pp I <br /> PMONE �I IE=V i.le �AC�C)!C, I L.�-LC/V..l (.� / / NLU <br /> 4Z5 - �54 - ���«' <br /> PROPOSED USE OF BUILDING f, Building MeCheniCel Addillon MEAT SOURCE <br /> PERMIT �_� CPmbination R Plumbing WORK � Altpration � Electric <br /> 7YPE �j Demolilion ❑ Sign 7YPE New Ges <br /> U S rinkler Re air/Maint. Other <br /> CONTRACT PqICE OF WORK CITY OF EVEREtT LOCAL SALES TA%CODE IS 3105 <br /> WORK DESCRIPTION , <br /> �(��f'nc1 i �l� R��� /�I�.r,�j <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTUPE OR 17EM NO. TYPE OF FlXTURE OR ITEM <br /> _ WATER CLOSET A/C-A/HANDLING UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BAS�N) _ HEAT PUMP <br /> _ SHOWER _ UNITHEATERS <br /> _ KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNORY TRAY WATER HEATER <br /> _ CIOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVEMTER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I - - <br /> � I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED TH�S APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF WWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED FiEREIN OR <br /> ', NOT. THE GRANTWG OF A PERMIT DOES NOT PqESUME TO GIVE AUTHORITY TO VIOLATE OF CANCEL THE PROVISION OF ANY OTHER <br /> �. STATE OR LOCAL LAW REGULATING CONSTRUCTION Ofi THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORRED BY THE <br /> OWNER OF THIS PROPEFTY TO PERFORM THE WORK FOF WHICH APPLICATION IS MADE AND I COMPI.Y WITH THE STATE <br /> I CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> Signature of Owner/ContractoUAuthorized Agent Date <br />