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P�.RMIT APPLICATI(`�.J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SIT ADDRESS `� � � � <br />�z3/- S' � �� <br />LEGA LOT N0. BLOCK <br />oEs�. y/'� y3 <br />OWNER <br />.�O/LG/UOvS?�i5' %�Cll/� <br />TENANTNAME <br />PARCEL TAX I.D. S <br />�3 CX�Saor'oo3� Y/ Do <br />TRACT <br />aooness � <br />yZ�/ S' s�' cz� <br />CONTRACTOR�� �/���'^, + q/„„ <br />;F.��y�.� <br />PHONE �7�5� 2�� � ��Z`/ <br />PROPOS D USE OF BUILOING I <br />O � '— I <br />CONTRACT PR�CE OF WORK <br />WORK DESCRIPTION <br />�ox �� <br />PLUMBI!eG <br />t�. � TYPE OF Fl7(TURE OR REM <br />� —O WATER CLOSET <br />I � BATHTUB <br />� _ LAVATORY (VJASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />i _ DISHWASHER <br />i _ LAUNOFYTRAY <br />CLOTHES WASHER <br />URINAL <br />� DRINKING FOUNTAIN <br />� FLOOF DRAIN <br />5ACKFLOW PREVENiER <br />_I SINK (SERVICE/EARlMOP/ETC.) <br />OTHER <br />PERMIT <br />TYPE <br />PERMIT M <br />c��9- oi� <br />�. iziz <br />�� u <br />CONTACT NAME ( �/I j PHONE <br />l�i/G /GO,PF�(9v.�.�;- ZS� • /2/2 <br />ADDRESS <br />S'�'� <br />�Buildi� n Mechanical <br />Combination � � Plumbing <br />Demolilion � Sign <br />Sprinkler <br />Iri <br />LP CONTR. LICENSE M <br />Adtlitian <br />Alterallon <br />New <br />Repair/Maint. <br />FiEAT SOURCE <br />n Electnc <br />B Ges <br />Other <br />CITY OF EVFREiT LOCAL. SALES TAX CODE IS 3105 <br />NO. I TYPE OF FlXTURE OR ITEM <br />A/C — A/HANDLING UNITS <br />_ FORCED AIR SY'STEMS <br />_ HEAT Pl'MP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />� WA7FR HEATER <br />MEl AL FIREPLACE/STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RANGE <br />_ GAS PIPING <br />EXHAUSTFAN <br />_ OTHER <br />I HEREBY CERITIFI'HA71 HAVE READ AND EXAMWED THIS APPLICATION AND NNOW THE SAME TO BE TRUE AND CORRCCT. ALL <br />PiiOVIS10NS OF L�1W5 ANO CRIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITN WHETHER SPEqFIED HERtIN OR <br />NOT. THE SRANTING OF A PERtd1T OOES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STA7E OF LCCAL IAW REGUTAT CO ON OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF i HIS THE W RK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTO W 2 AN 6. 0 <br />Signa�ure ol OwneuCoNractoUAuthonzed Agent Date I <br />D f <br />�� <br />