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( <br /> P F�MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 n, ) �� _�O <br /> 1' I`-' <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT r <br /> 23z � . ,�-,u� v,�w �2 . Do �a � � � �6 � G -o <br /> LEGA LOT NO. BLOCK TRAC7 <br /> DESC. <br /> OWNER I ADDAESS ZIP PHONE <br /> /ffsrlR ! �FiB//fi�^' I z 3 z Tf �tc�l�NK pR. 9ezoi 7s-y- �� �� <br /> TENANT NAME CONTACT NAME PHONE <br /> I p, pK�r��s� c�..i.r-�,J � zrs-z� so <br /> CONTRACTOR AODRESS ZIP CONTR.I.�CENSE <br /> o. P�dnas�-.I cwfr- I+a� o� �Zo��� �u��ucr. �.t 9sZo� <br /> PHONE y �lCF�GZ KS <br /> zs-- zsv-7,�s� g�o - �-3�-��- <br /> PROPOSED USE OF BUILDING 8uilding D Mechanical Addiiion HEAT SOURCE <br /> PERMIT �Combination I ) Plum6ing WORK R Alleretion Electric <br /> ��µ�j.� TYPE Demolilion � Sign TVPE D New Gas <br /> Sprinkler U Repair/Mainc Other <br /> CONTRACT PRICE OF WORK �p�p UJ� �y � O� CfTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> [� <br /> WORK DESCRIPTION ��SYY�+��-�KO� �C IE Z�' n 3� � �'"��� �K��� ��C# <br /> PLUMBING ���C.� MECHANICAL <br /> NO. TVPE OF FIXTURE OR REM NO. TYPE OF FlXTURE OR ITEM fJ 61��`C <br /> IWATERCLOSET _ P✓C—AlHANDLINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> UR�NAL _ FIFEPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BARIMOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBV CEFITIFY'HAT I HAVE READ AND E%AMINED THIS APPLICATION AN�KNOW THE SAME TO BE TRUE AND CORFiECT. All <br /> PROVISIONS OFlAWS AND ORIDINACES GOVERNING TFilS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEFEIN OR <br /> NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> I OWNER OF T�NIS PROPERTY OTPER ORM THE WORK OR WHICH APP'LICAT ON IS MAOE AND COMPLY WITH THE STq7E D BV THE <br /> iC i ORS L1W 1827 CW AND 296200 WAC. <br /> � G1.' / [�w . _ / - 7 -GZ <br /> Signature o O nerlContracrodAulhonzed Agent Date �/ <br /> L <br />