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� 'ERMIT APPLICA�'�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAfi �TREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> S TE ADDR�SS PARCEL TAX I.D.q PERMI7 q I <br /> � � ��I� MD3dl- Gz <br /> LEGA LOT O. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE yZs. <br /> Ro �a►�I� � r��t� san � � � t _S �C�,-� � `fS'�?� � �U� <br /> TENANTNAME CONTACTNAME PHONE <br /> 1 <br /> r�Yl�tc o�Q � <br /> CONTRACTOR �D,,J C,��, ���d��r.�I... P�HESS s[/r r hI�AU N���� Z�P e CONTR.LICENSE N <br /> 0. ""'� � J N /`/ �O7��i <br /> PHONE � 1 r 02 �-��G C�CJ ; y m y <br /> PROPOSED USE OF BUILDING Bllildi�g � Mechenical I AdAilion I HEAT SOURCE <br /> I PERMIT � Combination Plumbing WORK B Alteralion � Electric <br /> TYPE Demolilion Sign TYPE D New Gas <br /> Sprinkler U Repair/hlainL O�her <br /> I (.ONTRACT PRICE OF WORK �`� �QOO CITY OF EVEHElT LOCAL SALES TA%CODE IS 3105 <br /> I / I <br /> WORK DESCRI�TION <br /> I Vt'���-�c Q G{[� �nn�e.� �—'Wa-�1�`� a.'� -A.a�me10�0�'�'� <br /> i D__ <br /> I PLUMOING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM N0. TYPE OF FI%7URE OR ITEM <br /> VJATEh..;LOSET A/C—A/HANDLING UNITS <br /> BATHTI B FORCED AIR SYSTEMS <br /> LAVATOh�(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES ORYER <br /> DISHWASHER RANGE HOOD <br /> L.AUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METALFiREPLACElSTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKWG FOUNT.4W � GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTEii GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHFR OTHER.__ <br /> I HEREBY CEFITIFY'HAT I HAVE READ AN!]EXAMINED THIS APPIICATION AND 1(NOW THE SAME TO BE TRUE AND CORRECL ALl <br /> PROVISIONS OF L1W5 AND ORIDINACES GOVEflNING THIS TYPE OF WORK WILL BE:OA7PLIED WITH WHE7HER SPEC�FIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUh1E TO G�VE AUTHORIlY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> S7ATE OR LOC 1L LAW REGULATING CONSTRUC�IQN OR TFiE PERFORMANCE OF CONSTRU�.TION. THAT I AM AUTHORIZED BY THE <br /> OWNEP OF THIS PROP'cR1Y TO PERFORM THE WORK fOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTOFS LAW 1827 'N AND 296 0 WAC. <br /> ��c� ti'�,c— d/'�`I�03 <br /> SignaWre ol Owner/Cortiractor/Au�nze 'Agent Dat. <br />