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' . ERMIT APPLICAT�. JN <br /> � CITY OF EVERETT PERMIT SERVICES .�1 '�� <br /> �"" 3200 CEDAR STREET, EVERETT, WA 98201 h m� <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS pApCEL TAX I.D.M PE AtIT a <br /> 9801 �.s+ Ave, S.E . O c7 '-I o � oo� O �da i ( -o�l <br /> LEGA LOTNO. BLOCK TRACT <br /> DESG � �� � o _ � Sf�lTERC"�T �� , '� <br /> OWNEH ADDRESS ZIP PHONE <br /> ,�e�{'et�. 1�, �v �s ��6 �•/ ��,c",lyn RNe , E�e.•e1! 1,�A9$�� 'iZ5-2i�-S�v1 <br /> TENANT NAM CONTACT NAME PHONE <br /> T; m B��,n�ne� 3efr �q„� s `IZS-290 S�o � <br /> CONTRACTOR AU�RESS ZIP CONTH.LICENSE M <br /> PHONE 0���{' <br /> PFOPOSED USE OF BUIL�ING Building � Mechanical Adtlilion HEAT SOURCE <br /> PERMIT �C�mbinalion Plumhing IWORK � AltPration I �Electric <br /> 1_ (� TYPE Demolilion Sign 1YPE New Gas <br /> r`� 1 S rinkler Re air/Maint. Other <br /> CONTHACT PRICE OF WORK ��JF3/_— CITY OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> U� <br /> WORKDESCRIPTION �`^ �� ne�, qc�.(G��' c�Yl 'e�C�S�'•v�g �JT L <br /> J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI7CTURE OR REM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C—AlHANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ �AVATOFY(WASH bASIN) HEAT PUMP <br /> _ SHOWER UNITHEATEFS <br /> KITCHEN SINK 8 DISPC',SAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> _ FLOOR DRAIN GAS RANGE <br /> , BACKFLOW PREVENTER � GAS PIPING <br /> � _ SINK(SERVICElBAR/MOP/ETC.) _ EXHAUST FAN <br /> i _ OTHER _ OTHER <br /> I <br /> � I HEREBY CERITIFY'HAT I HAVE READ AND EXAIdINED THIS APPUCATION AND KNObV THE SAME TO BE TFUE ANO CORflECT. ALl <br /> , PROVISIONS OF LAWS AND OflIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHEfHER SPEqFIED HEREIN OR <br /> i NOT. THE GRANTING OF A PERMIT�OES NOT PRESUME TO G�VE AUTHORITY TO VIOWTE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL L:1W REGULATING CONSTRUCTIGN OR THE PERFOFRIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THF <br /> iOWNER OF THIS PROPERTY TO PERFORM THE WOflK FOR WHICN APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOFS LAW 19.27 RCW AND 296200 WAC. <br /> /�^ <br /> ���,/�,a c�. c���� II-3-oZ <br /> I Signalur��0�wnelf ontractor/Authonzed Agent Date i/ <br /> ; '' 2 <br /> I <br />