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� 7 -lI-02 i <br /> � CRMIT APPLICAT�JN <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98'_'O1 <br /> 425-257-8810 - FAX 425-257-8857 <br /> S� I�pDRI� (.�l � G 1��V'Q N�Q— I PARCE�_TAX I.D.# ( PERMi7 nr�"J ' C�I � <br /> / �a <br /> LEGA LOTNO. BLOCK .�IACT <br /> DESC. <br /> I OWNER ADDRE55 i/f.✓1 � �� ZIP PHONE�N � <br /> ' p►�vid.�Nc� ���1t (It�d�r�l C�tit�er� �v.�.Q1t wA ���za � � ��Q '1902 <br /> TENANTNAh1E CONTACTNAME PHONE <br /> �?� ,n1C, � P�u�c� (�Jc� lnob � � �t25 � Z58 -790� <br /> CONTRACTOR �C�rt�u ['�j E I U oADDFES i�� ��ree� ZIP ��i nTR.LI�CHNS2�� �i <br /> l 2 ti:� r <br /> PHONE(3r;o) 56�i —?.�I �J ��`VVI�f"�SVI VV � �� C t I i <br /> PROPOSED USE OF BUI_DING Building D MeChaniCal D'Adtlilion NEAT SOURCE I <br /> i � � � PERh11T Combinalion I ) Plumbing WORK 'y�Aqeration r1 Electric I <br /> I I I TYPE DemOliliOn � Sign TYPE New Gas <br /> � � ' .-� � -� Sprinkler � Repair!tdaim Other <br /> CONTRACT PRICE OF WORK '1 G��17O0 GTY OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> WOPK DESCRIPTION �/1 � I � ��O � ( . � � � ��.I S � C/ QUV Q — <br /> i �IU ���� �/I�C� C�.1 /�lo� . <br /> 0 <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITE�d NO. TYPE OF FIXTURE r`R ITEM <br /> � _ WATER CLOSET _ NC—A/HANDUNG UNiTS <br /> � BATHTUB FORCED AIR SYSTEMS <br /> ��. LAVATORY(WASH BASIN) HEAT PUMP <br /> �, _ SHOWEF7 UNIT HEATERS I <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> _ DISHWASHER RANGE HOOD I <br /> �i _ LAUNDRY TRAY _ WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE.�STOVE <br /> I URINAL FIREPLACE INSERT <br /> I _ DRINKING FOUNTAW GAS FIREPLAC� I <br /> ''� FLOOR DRAIN GAS RANGE <br /> , _ BACKFLOW PREVENTER GAS PIPING I <br /> _ SINK (SERVICEBAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER _ OTHER I <br /> � <br /> — — I <br /> I HEREBV CERITIFY'HAT I HAVE READ AND EXA�dWGD THIS APPLICATION AND KNOW THE SA61E TO 6E TRUE Ah!J COFREC7. ALL I <br /> PROVISIONS OF LAWS AND OPIDIiJACES GOVERNIIJG THIS T'PE OF VJORK N'ILL BE COMPLIEG WITH WHETHEFl SPECIFIED HEREIN OR <br /> NOT. THE GRAf�TING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITI TO VIOLATE OR GANCEL THE PP.OVISICN OF ANV OTHER <br /> STATE OR LOCAL LAW REGULATING GONSTFUCTION OR TNE PERFORMANGE OF CONSTRUGTIOI'. THAT I Ald AUTHOiiIZED BY THE <br /> pWNEP OF THIS PROPERT�'TO PERPCRM THE WOFK FOR WHICH APPLICA i ION IS M11ADE AND I COMPLY YJITH THE STATE II <br /> i CONTR/{CTOR$LA6V 1827 R�JD 296200 WAC. <br /> / � � <br /> i <br /> L/ D <br /> Signature of Own d omractor/Authonzed Agent Oate <br /> '�z�� <br />