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, P�r2MIT APPLICATIO�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 I PERMi7# <br /> U�(p ' � � JQ/ C�O�`�1 tS01 C90 6a <br /> LEGAL LOT N0. BLOCK i RACT� <br /> DESC. I � �n q � 1 <br /> OWNER ADDRESS ZIP PHONE <br /> Ada� r �n�er�r��e �� u--C ��032- 35� AJe�t Px�th .11 �go� z 4z�-�g3-i�i � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ' I Ma+i IP�SIey 91� -3�5-�Oq3�l <br /> CONTRACTOR ADDRESS � 21P CONTR.UCENSEX <br /> /�cia�r [n-1Prpri�si�-�-�� I�C�'z-3��+r�1ve ;iL- l�i"11C �� `Y�,OIZ ADA�RELo 3zC � <br /> PNONE <br /> PROPOSEDUSEOFBUILDING pERM1T 1�1 Sp nk'Ieation I�,�'Plumbing I WORK I,-(9tlPairlMaint. HEATSOecVic <br /> cJ�r� 7YPE H Demolilion � Sign TYPE �y-New �as <br /> r1 �! L) Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION <br /> ►�w �-�;r,�� �n�, �y r��,���� ��� # ZZss <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTi1RE OR IiEM <br /> s WATER CLOSET(TOILET) A/C-AIHANDLING UNITS <br /> Z BATHTUB = FORCED AIR SYSTEMS <br /> ,� LAVATORY(WASH BASIN) U HEAT PUMP <br /> � SHOWER U UNITHEATERS <br /> �_ KITCHEN SINK& DISPOSAL = CLOTHES DRYER <br /> _L DISHWASHER � RANGE HOOD <br /> I LAUNDRY TRAY � WATER HEATER <br /> I CLOTHES WASHER D METAL FIREPLACE/STOVE <br /> o URINAL U FIREPLACE INSERT <br /> u DRINKING FOUNTAIN T GAS FIREPLAr,E <br /> �l FLOOR DRAiN —� GAS RANGE <br /> BACKFLOW PREVENTER � GAS PIPING -- -� <br /> i O SINK(SERVICE/BAR/MOPIETC.) EXHAUST FAN <br /> OTHER OTHER <br /> — — r <br /> � <br /> - — ; � e��� <br /> i� i HEREBY CERITIFY THAT I HAVE READ AND EXAMWED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORR CT. A <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TYPE OP WORK WILL 8E COMPLIED WITH WMETHER SPECIFIE ERE tJ <br /> ' NOT. THE GRANTING OF A P�RMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF A Y�tl'fHER <br /> � STATE OR LOCAL LAW RE3ULATING CONSTRUCTION OR THE PERFORh1ANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OIVNER OF THIS PROPERTY TO PERFORM1I THE WORK FOR\NHICH APPLICATION IS MADE AND I COMPLY WITH TNE STATE <br /> CONTRACTORS LAW 18.27 CW AND 296.200 WAC. <br /> ' `�/''�L-N7� � -Z�-��I <br /> Sig ature of OwneNContractor/Authonzed Agant Date <br /> i DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> 1'2 <br />