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PLRMIT e4PPLICATI��v <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32G0 CeDAR STRcET, EVERETT, WA 98201 <br /> I 425-257-8810- FAX 425-257-8857 � G�.o9-G/� <br /> � Iq�� <br /> SITE ADDRESS �:2�.� �� PARCEL TAX I.D.A PERMIT n <br /> �-'J l� �e�.,:�J �uL- �{ _ �� <br /> LEGA LOT N0. BLOCK CT <br /> DESC. � d. � � N� r 1J . � ).b� <br /> OWN R � DRESS ZIP PHONE Z5"' <br /> c�C� 1�Uar� /.3 �. �Gv:es Ivv ? 2c( I(,C S�«c,a� t95 -��W <br /> TENANTNAME CON ACT ORPERMIT PHONE <br /> � e� yl�"� y'�3 - a o� <br /> CONTRACTOR G�G��, �UMeS 1� ADDRESS� �� _ A_�� ZIp CONTR.LICENSE� <br /> PHONE�7ZJ ) � ! ' OODU �OL I SIZ 1 rIG= /Jl� ✓ 3G[,Gire{ I CI��L� <br /> � IV_ SfcJc.�s c✓� . <br /> PROPOSEU USE OF BUILDING ��-Q( Building R Mechanical Additlon HEAT SOURCE <br /> I �� V � S �2 . TYPEIT V SP nkleoo n U Sign bin9 �E � RaPaidMainL Mt OMer c <br /> CONTRACT PRICE OF WORK �G_ vG U �"� _ �-CiTY-0F,EVERETT LOCAL SALES TAX CODE IS�105 <br /> U <br /> WORK DESCRIPTION / ' <br /> i � <br /> 3�,.' 1 c� A rv e �.a , '� � ��� <br /> ��� U � Sr"2 � J , l-� C. ��'U <br /> PLUMBING \ � MECHANICAL <br /> NO. 7�PE OF FIXTURE UR ITEM �"Fb. TYpE OF FIXTURE OR ITEM <br /> � WATER CLOSET(TOILE� A/C-A/HANDLING UNITS <br /> BATHTUB 1 FORCED AIR SYSTEMS <br /> � LAVATORY(WASH BASIN) HEAT PUMP <br /> �_ SHOWER UNITHEATERS <br /> � KITCHEN SINK& DISPOSAL � CLOTHES DRYER <br /> � D�SHWASHER R,4NGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> I CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN 1 GAS f'IREPLACE <br /> FLOOR DRAIN � GAS R,4NGE <br /> BACI<FLOW PREVENTER ! GAS PIPING <br /> SINK (SERVICE/BAWMOP/ETC.) 1 EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFV THAT I HHVE READ AN�EXA�v11NE0 THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L4W5 AND ORIDINACES GOVERNING THIS T'PE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRAN i ING GF A PERMIT DOES N07 PRESUME TQ GIVE AUTF!ORITV TO VIOLATE OR CANCEL THE PROVIS!ON OF ANY OTHER <br /> STATE O�i AL�A ULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TFiAT 1 AM AUTHORIZED BY?HE <br /> OWNER OF THIS i'ROPEP.TY 0 PERFORM THE WORK FOR WHICH APPLICATION IS MADEAND I COMPLY WITM THE STATE <br /> CON7`RAC70RS LAW 18.27 R W AND 296200 W C. <br /> \. �,{ � <br /> Signature of OwnerlC actor/Aui zed Age t Date s� `�(pJ S <br /> BIT 8 IT CARDS ARE NOT ACCEPTED <br />