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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 TA7(I.D.�I PERMIT M <br /> �� C�k> o3c,� Z � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNEfl fL�L/�Ct ��rIJ /G �:���.��/f��S ADDRESS ZGIP PHONE <br /> .C�N� fYZ7 `(J/L7j�//✓� �ZG'J~ Cl.'� �BZC�� 'f�I�'�J�7'7OL�� <br /> J <br /> TENANTNAME I CONTACTNAME PHONE <br /> CONTRACTOR �e� CUIIS�F1'qG7"�C�i'1 ADDRESS . . LP CONTR.UCENSE• <br /> s���„�,«: ��- �n� 15405�5�. 37*^S� s�2on <br /> PNONE , , i3E�i >ev ue 9�i��1(�, F'C1CC.�5 i OS'9 Nlv <br /> �Z5= �54 - �OZ[: <br /> PROPOSED USE OF BUILDING �E,PEIT Demmol9otnon R S 9n bingal nPEK B Repe(ri/MaInL HEAT SGIeS�E <br /> D R�( <br /> Sprinkler U Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT!_OCAL SALES TAX CODE IS 3105 <br /> WORK DESCflIPTON . <br /> ��m��l� �l� R��� ��i��,�j <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FU(TURE OR ITEM <br /> WATER CLOS[T A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIF SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> j _ DISHWASHER RANGE HOOD <br /> � LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIRFPLACE/STOVE <br /> URINAL PIREPLACE INSERT <br /> DRINKING FOUN7AIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> j _ BACKFLOW PREVENTER GAS PIPING <br /> I = SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> ' I HERE81'CERITIFY THAT I HAVE READ AND EXAMINED THIS 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 WNETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOPITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL W W REGULA'ING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> � OWNER CF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br /> �� CONTR.4CTOFiS LAW 18.27 RCW AND 29fi200 WAC. <br /> I <br /> Signawre of OwnevContractodAulhorized Agent Date ��/ <br /> � <br />