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��ERMIT APPLICA�..�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8957 <br /> SI7E ADDRESS PARCEL TAX 1.0.M P �IT K <br /> �5aa U_ La� � ov 43� o0o as7 v3 � �ZI� -GG.� <br /> EDGE ATER BLK 000 D•03 e 42Fi oF TR <br /> LEGA LOT IJO. <br /> DESC. ��8�W 41 FT OF TR 57 AS MEqS lJ.,G S <br /> OWNER W i ��h µ ��N 7HOF TGW W 7FT OF E 49FT SD TR LP PHONE <br /> l�'l ona 1�.� LT�eu�T) 3sa� -��� ., . . C,u.��-( -�J��o3 �zs- <br /> TENANTNAIAE CONTACTNAME ./ PHONE <br /> ! �10YL4.iLq.v(.. I �rTI�IZ I►1G�1_n�t� V?'S— �08—SV3�U <br /> CONTRACTOR �� ' C�,.a.�� � pD�D(j�ESS /j��j�j �ls Q� � �, ZIP CONTR.LILENSE M <br /> /.��(.rI4NI��1l w4` fr}l.13�j �, <br /> l <br /> PHONE��O �5���� s pcou «( p rk I <br /> — — i <br /> PROPOSED USE OF BUILOING I BUilding Mechanical p�r{, Addiiion HEAT SOURCE � <br /> PERMIT COmbinetipn R�.J Plumbing WORK u Alteralion Elechic I <br /> �,5���� �„�� TYPE � D�molilion �U Sign TYPE �„j Nep I � Gas <br /> U S ririkler U Re airRdainl. U Oiher <br /> CGNTRACI'PRICE OF WORK /pp��' /^ ! /n, ._ CITY OF EVERETT IOCAL SALES TAX COOE IS 3105 <br /> i0 �i L <br /> WORKDESCRIPTION /_ A I IL�` �L � <br /> �ua��c ftt1�Y, rr <br /> , PLUMBING MECHANICAL <br /> INO. TVPE OF FIXTURE OR ITEM NO. 1YPE�JF FI%TURE UR ITEM <br /> ! ,L_ WATEA CLOSET _ NC—A/HANDLING UNITS � <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> = LAVATURY(WASH BASIN) r HEAT PUMP � <br /> � SHOWEFi � _ UNIT HEATEFS i <br /> _ KITCHEN SINK 8 D�SPOSAL CLOTHES DRYER �I <br /> DISHWASHER RANGE HUOD � <br /> I _ LAUNDRY TRAY ,� WATER HEATER <br /> � __ CLOTHES WASHER _ METAL FiREPIACE/STOVE <br /> I = URINAL _ FIREPLACE INSERT <br /> DFINKING FOUNTAIN _ GAS FIREPLACE � <br /> � _ FLOOR DFAIN GAS RANGE <br /> I _ BACKFLOW PREVENTER GAS PIPING <br /> SINK (SERVICEi�AR/MOP/ETC.) � E:KHAUST FAN � <br /> � _ OTHER _ OTHER <br /> � <br /> � <br /> � —' — — <br /> i <br /> , I HEREBY CERITIFY'HAT I HAVE READ�NII EXAMINED THIS APPLICATION AND KNOW THE SAl1E TO BE TRU:AND CORPECi. 'vLL <br /> �. PROVISIONS OF W WS AN�ORIDINACES GOVERNING THIS TYPE OF N'ORN WILL BE COMPLIED WITH WHEfHER SPEQFiED H[REIN 09 <br /> � NOT. THE GRANTING OF A PERMIT DOES YOT PRESUAIG TO GIVE AUTh10RIT/TC V�OWTE OF CAVCEL TNE PFOV!SION O�ANY OTHER <br /> SiATE OR LOCAL LAW REGULITINC CONSTFUCTION OR THE PERFORMANCE OF CONSTFUCTION. THAT 1 AM 4UiHORiZED 8Y THE i � <br />�� OWNER OF THIS PFOP[RN TO PERFORM1I THE WORh'FOR WHICH APPUCATION IS tiIAL�E AND I COh1PLY WITH THF S�A i E I <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> ,� - n ^� I <br /> 0�6� � / e" -- <br /> Signa ture ol 0���� a7 CoNrac tor/Aui hor¢e d Agent � Uate �/z 1� <br /> J <br />