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. — <br /> PERMIT APPLICATION <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.il P RMIT# <br /> Z � M Z = � F OoSN oo Z o3ba o D� ' -�'�' <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. 30-31 -3Z Z'7 pING JPS"— p�ViSiO� � <br /> OWNER ADDRESS ZIP PHONE �'?5_ <br /> OLE � MAT��I CNz�Sr:�Nrp�J Zcci Mo,a�2�� AVE �/Bzc3 353 - �45'Z <br /> TENANTNAME CONTACTNAME PHONE <br /> � SAMr � ( Jns�,� nna..a.y �/2s- 3��1�(• ys-io <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSEN <br /> I'lrlib )-1 L11`I�S Co/.�Si• IAIC.. �pb'�� 72�� S.— NF L <br /> PHONE ,� � / IAJISCL °}bbTL <br /> \-�-(p �AR�/S�/i�cr 9PL7u <br /> PROPOSED USE OF BUILDING uilding D Mechanical Addition HEAT SOURCE <br /> , � G I PERMIT �ombinalion �J P�9mhing IWORK �Alteration D Elactric <br /> Ex�STI ���j TYPE Demolilion U Si n TYPE New U Gas <br /> �n�Gr Sprinkler RepainMaint U Other <br /> CONTRACT PRICE OF WORK 3� SO a '" CRY OF EVERETf LOCAL SALES TAX CODE IS 3'� 15 <br /> WORKDESCRIPTION ADili/Jl.� FOJNA�T�D� UN��G2 1�X�5� i��- ��1i7AC�r (A14�.�$ <br /> /��,I,p �JEW SL413 �LOG/Z <br /> A[�il;r��,. W4�. {$1=H c.i r11,� <br /> FLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR REM <br /> WATER CLOSET NC-NHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> L�VAi ORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNORY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACEISTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRI11N G�S RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICEIBAR/MOPIETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY iHAT 1 HAVE REM AND EXAMINED THIS APPLICAiION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF I.AWS AND ORIDIN�CES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOi PRESUME TO GIVE AUTHOIiITY TO VIOLA7E OR CANCEL THE PROVISION OF ANY CiHER <br /> STA1 E OR LOCAL LAW REGULATING CONSTRUCTION OR iHE PERFORMANCE OF CONSI RUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF iHIS PROPERTY TO PERFOItM THE WORK FOR WHICH APPLICA710N IS MADEl�ND I COMPLY WITH THE STATE <br /> CONTRACTORS U1W 1827 RCW AND 2�Jfi200 WAC. <br /> .,�.,r, : � �� �3 - a 4 <br /> Si naWreolOwne/ConlractorlAuthon Date <br /> , I/Z <br />