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r � <br /> P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETi',WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> StTE DDRESS PARCEL TAX I.D.N P RMIT <br /> z� ?Z em� �555LOCboa7oa I►�o.�io -03 � <br /> IEGAL LOTNO. BLOCK TRACT <br /> I)ESC. <br /> OWNER A�DRESS LP PHONE <br /> �,��a� U��.hi,�/� ��d-�- 7�'►�Scnv� !� ��ar.�-4�3 � 33sFS"Q7 <br /> TENANTNAME CO AGTFORPERMIT PMONE <br /> I ��zl rce� �a (�v- ao ro ��{�o <br /> CON7RACTOR UJ�-f �V1C Q67C 1t1/� �DRESS �� ZIP CONTR.UCENSE k <br /> . ,) � JO <br /> PHONE� Z�Z 4�� Z�o�-r�� � w 9�I44 Yl/ASN�� �)6s <br /> PROPOSEGUCEOFBUILDING Buildfng �Mechanical Addltlon HEAT90URCE <br /> PERMIT B Combination Plumbing WORK B AltewUon �Electric <br /> TYPE ❑ DemolNion Sign TYP! Q New �as <br /> U Sprinkler U RepairlMainl. Othar <br /> CONTRACT PRICE OF WORK / .,O/1� — CITV OF EVERETT LOCAL SALEB TA%CODE IS 7105 <br /> LU �� <br /> WORK DESCRIPTON <br /> � � �� �J�d� � �� �n� �� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO.. TYPE OF FI%TURE OR ITEM <br /> WATER CIOSET(TOILEn _ AIC-AMANDLING UNITS <br /> BATHTUB _ FORCED AIR SVSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> � KITCHEN SINK A DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEATER <br /> CLOTHES WASHER _ _ METAL FIREPLACEISTOVE <br /> URINAL _ FIREPLACE 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 HEREBY CERITIFY THAT 1 HAVE READ AND FXAMINED THIS APPLICATION AND KNOW TME SAME TO BE Tf3UE AND CORREGT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING TMIS TYPE OF WORK WILL BE COMPLIED WITH WHEfMER SPECIFIEO HEREIN OR <br /> NOT. TME GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TME PROVISION OF ANY pTHER <br /> STATE OR LOCAL IAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM:,JTHORIZED BY THE <br /> OWNER OF TFiIS PROPERN TO PERF9RM THE WORK FOR WHICH APPLICAiION IS MADE AND I COMPLY WITH THE STATE <br /> C CTORS LAW iB.27 RCW AND 186.200 WAC. <br /> �b� <br /> Sgn r o wnerl nVactodA oriza nt ate <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> ['d LSBBLS252hT�01 �WO2l� 6£�L0 £602-22-1J0 <br />