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�•1AP.-?4-2�05 18:39 FROt9: T0:14252578857 P•4 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> ' , � , 4Z5-257-881 A—FrUC 425-257-8857 <br /> . %� ��. � <br /> SITE AODRE S PAFCEL TNC�.D.11 PEtiRVT A <br /> 3 33 ka.J'dr ooY377� 3ooiCo�z � rnas �r3-Ua�. <br /> IEGAI LOT NO. BLOCK TRACT <br /> nesc. — <br /> OWNER ADORESS 21P PHONE Z�_ <br /> i.�, WrD KDs��2 35<33 k�a� �.��,��I- l,�A� �'�vl �y�- �Zs� <br /> TENlWT NM!E CONTACT fOR VERMIT VHONE <br /> S'aY►t-t1 I �iz�L� 1zs 7 zo 3� <br /> CONTR CTOR AOORES;r ZIP COMRLICENSEA <br /> PMwAs,� �rzargr1 �'¢rt�Gal ,�,� Gr�.Jyyr�f97ic�s <br /> � z8 Z cr� �� 7`harn ��e" 'z'✓��4�/9 <br /> PROPOSEU USE OF BUIl01NG � BUilding �Mlthenlql Addlllon MEAT SOURCE <br /> PERMR Combina'.bn Plumbinp WDRK R Nleralla� [� Elearit <br /> �� TYPE Demolil:on Slgn 1Y�'E D New U G� <br /> Syrink�or � �epnirlMalnl U o�+u <br /> CONTRACT PRILE OF WORK ��v'O� � CRY OF EVEREIT LOLAL SALES TAX CODE 15 7105 <br /> WORK DESCRIPTION �G I .�� <br /> �as -� g� �.c,�-(� G�4-�- � <br /> PLUMBING MEC A ICAL <br /> NO. TYPE OF FIYNRE OR ITEM NO. YYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILEn _ AIC-A/FiANDLING UNITS <br /> BATHTUB _ FORCED AIR SYS7EMS <br /> IAVATORY(WASH BASIN) _ HEAT PUMP <br /> ! SHOWER _ UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHE3 DRYER <br /> D�SliWASHER MNGE HOD� <br /> LAUNDRYTHAV = WATER HEATER <br /> CIOTHES WASHER _ A�ETAL FIREPLACEISTOVE <br /> URINAI _ FIREPIACE INSERT <br /> ORINKING fOUNTAIN GAS FIREP(ACE <br /> FLOOR ORAIN _ GAS RANGE <br /> BACKfLOW PREVENTER _ QAS PtPING <br /> SINK�SERVICEIBAR/MOPIETC.) EXHAUST FAN <br /> OTHER _ GTHER <br /> I HEREBY LERRIFY THAT I HAVE READ AND F�WMINED 7HIS APPIICATION AND KNOIN THE SAME TO BE TRUE ANO CORRECT. ALL <br /> PROVISIONS OF IAWS AtJD ORICINACES GOVERNING T195 TYPE OF WORK WILL BE COMPLIED WITN WHETMER SPECIFIED HEREIN OR <br /> NOT. TNE GRAPRING Of A PERMIT DOES NOT PRE9UME TO GIVE AUTHORIN TO VI�>IATE OA CANCEL TNE PROV�SION CF AM'OTHER <br /> OW ER OF 11i S PROPERN O FcR ORM THE WORK FORHWM�CH MPIICP�TION IS M4DERAND I COMPLY WfM E SOTqTE D 9Y iHE <br /> Cp�CTORSIA 27 RCW AND 298.2 Q/(�� <br /> ✓� <br /> (�lcr�a �4-Lc! <br /> 5' el re o OwnerlCanVaclorlA i nza qqonl ate <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />