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PLRMIT APPLICATI��� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> --� I�-'' � D G�-o9 ��� <br /> SI7E ADDRESS l- PARCEL TAX I.D,X - I <br /> J�y/ �- � , I PERMIT# _ <br /> (II ��J ('� e �,� (��c: �O�, y� '�-U - t�2� -cr� <br /> LEGA LOTNO. BLOCK '¢'4CY <br /> DESC. � � _ • �. � <br /> �� OWN R ' �' 'J � S.o� <br /> DRESS ZIP PHONE Ir- <br /> ; ! e� I�.c�a� /3 F i�u���S i�� � 2�( lu S �«�,�� 155 -��� <br /> � ITENANTNAME I CON AC�RPERMIT � PHONE <br /> CONTRqCTOR e� y1j^ y'� -a U� <br /> �«�• KC7M[S G�- ADDRESS 3 _ A_y� ZIP CONTFtLICENSER <br /> PHON�/7ZJ l GLI SIZ 1 �C /JL�1 ✓ �YY�C..l�f�iCl��(LF <br /> I J L J�'I - � $UG II�C C�r C.,�1 wA <br /> PROPOSED USE OP BUILDING Bwldmg Mechanical I Atlaitlon HEA T S O U R C E <br /> I P E R M I T � Com bina tion � p lumbing WORK � Alteration R Electnc <br /> I ���,J � S r 2 T�PE Demolition Sign ITYpE New �j Gas <br /> Sprinkle� Repair/Malnt. bQ oma� <br /> CONTRACT PRICE OP WORK G'G ��J U . w �-.-C{ry-pp.EVERETT LOCAL SALES TAIC CODE IS]703 <br /> i 1 U '\ <br /> � WORK DESCRIPTION / � <br /> i ��..� 1 e� A rv ea +...� � <br /> I' 1v9 �� � sr2 � J � ��1 � � d-� <br /> PLUM BL.f, MECHANCIC-AL <br /> � NO. TYPE OF FIXTURE OR 17EM \ � <br /> , �F6. . TYPE OF Fll(TURE OR ITEM <br /> � WATEk CLOSET(TOItET) A/C-A/NPNDIING UNiTS <br /> BATHTUB 1 FORCFi�AIR SYSTEfdS <br /> � LAVATORY(WASH BASINj HEAT PUMP <br /> SHOWER UNITHEATERS <br /> � KITCHEN SINK 8 DISPOSAL � CLOTHES DRYEF <br /> � DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> 1 CLOTHES WASHER METAL FIRE�LACE/STOVE <br /> _ URINAL FIREPLACE INSER'� <br /> _ DRINKING FOUNTAIN 1 GAS FIREPLACE <br /> ,_ FLOOR DR,4W � GAS R,4NGE i <br /> _ BACKFLOW PREVENTER I GAS PIPING <br /> _ SINK(SERVICE/BAWMOP/ETC.) I EXHAUST FAN <br /> OTHER — <br /> — OTHER <br /> I HEREBY CERITIFY THAT I HAVE REA�AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT, q�� <br /> PROVISIONS OF LqWS AND ORIDINACES GOVERNING THIS 1'PE OF WORK WILL fiE COMPLIED WITH WHETHER SPECIFIED HERE�N OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TG VICIATE OR CAN�EL THE PROVISION OF ANV OTHER <br /> ST<.TE 0&tIIL`AL L4 LATING CONSTRUCTION OR THE PERFORMANCE OF CON5TRUCTION. TF{qT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPER7Y 0 PERFORM THE WORK FOR WHICH APpLICATION IS MADE ANO I COMPLY WITH THE STATE <br /> CON RAC i ORS lAW 18.27 R W AND 296.200 W C. <br /> n � <br /> Signature of Owner/C actoNAut izetl Age t Date s�� ���� S <br /> BIT & IT CARDS AaE NOT ACCEPTED <br />