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�ERN19T APPLICATION � <br /> CITY �F EVERETT PERMIT SERVlCES � <br /> 3200 CEDAR STREET, EVERETT. WA 98�0� I <br /> 425-257-8810 - FP,X 425-257-9857 <br /> P�� ����� ��� � <br /> SITE ADDRESS I pARCEL TAX I.D. R I �eHrair- j <br /> 'ISU y --(��–�-�1'—ri'�L.��(2�.�I1P[� o� c,o39r; :. -cco- osv -c'=� i�_ �� �� I <br /> LE�;�,J LO MO. I gLOCK TRACT i <br /> L`-'c l Lo�-�a� SPo�.-oT� �: <br /> OVJNER ADDRESS ZIP PHONE � <br /> _ �0,.�2. En,��t�ses L� �Zo�a-3s�Au� st 30�1'�.� �t�so��. 4as-t�k3 ! <br /> TENANT NAME I CONTACT FOR PERMIT PNONE �7�� <br /> - I �t�� �..GS�S�� �a-s - ��3 -1� �g __ <br /> CONTRACTOR ADORESS 21P CONTR.LICENSE vi <br /> (-�-cl'4.12 Evt-��JR.�s�S� L�.c. �-�o�a-�s�'�}u�sE C',�fi� gs���- A��s-e�� 3��, <br /> PHONE <br /> PROPOSED USE OF BUILOING BuildincJ �i�lech3nical I ^l Adtiilion HEAT�OURCE <br /> ,�J"���,e �� PERMIT Combinalion �lumhing WORK AlJeiatiun E!ecllic <br /> _ ' n�., � iYPE Demoli�ion Sign TYPE �✓tiew �y"Gas <br /> „J��A1.�x I Sprinkle� I �-� RenzirrP,laint � Other I <br /> CONTFACT PRICE OF WORK I CITY OF EVERETT LOCAL SALES 7AX CODE IG J705 — �� <br /> VlORI(DESCRIPTION � <br /> i� e.w o�c��1,e., �•�� -�--�- �je.aw� a�-39 <br /> PLUMBING I MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEh7 NO. I TYPE OF FIXTUPC OR ITEM <br /> _I 4VATFRCLOSET(TOIL[T) A/C-A/HAN�IINC, JNITS <br /> � BATHTUB _L FORCE�AIR SYSTEIv15 <br /> y_I i.AV.4TORY(WASH BASIN) HEAT PUA1P <br /> � SHOWER UNITHEATERS <br /> �I K!TCHEN SINK 3 DISPOSAL __j_ CLOTHES DRYER <br /> __L� DISHWAS'HER RANGEHOOD <br /> 'i LAUNDRY TFAY _j_ WATER HEATER <br /> -( . � CLOTHES WASHER __ METAL FIREPLACF:STGVE <br /> ' URINAL FIREPLACE INSERT <br /> _ . _� DRINKWG FOUNTAIN �_ GAS FIREPL.4C[ <br /> FLOOR DRAIN �_ GA3 RANGE <br /> �. _�-� BACKFLOW PR[VENTER � � GAS FIPING <br /> SINK (SERVICE'BARIMOP/ETC.) � EXHAUST F-1N <br /> __ _��, OTHER _ OTHER______ <br /> -- - � - I — — -- <br /> -. 'E3Y CERITIFY THAT I H.4VE READ:1ND E;�AtdiNED THIS APPLICATION AND KNON'THE SFME TO BE TRUE:•i��U �'-:��% 'i. . <br /> . �`..S��UNS OF L41h'S AN�ORIUIMACcS GOA'ERNING THIS TY'PE OF 4VORK IVILL Oe COI.iP�_IE�l:9TH l^JHFTHeR 5PE?IP E:� rci�=.'bl�i�� <br /> �.�iiT. -HE GRANTIIdG OF A PERAfIT DOES NOT PRESUPAE TO GIVc i.UTHORITi TO VI01ATc OR C:.tJCEL THE PROVISiI'd:�i= ��I� OT!-,c�1 <br /> 3-ATE OR LOCAL L.:tV REGUWTING CONSTRUCTION OR i HE PERFOFMANCE OF COMSTRUCTION. THAT! AA1 AUTHOG'=E!) cv ",,_ <br /> �]','iNER Q='HI$pRpPERTY TO PERFOHf.1 THE`.NORK FOR\VHICH APPLICATION IS F.IADE i+ND I CCi!Pt.Y'.VITH THC ST..-= <br /> :ONTRA.��.-O?5 L.;�:! '9�7 RC'.:'AHD.:9d_��0 VJAC. <br /> ;��'":���,AA� (n� �14i1 v y �� <br /> � �.nai,Contrcc;ocAi �r� nzed Agent Date � � <br /> DC31T 3 C�EC1- CARDS .aR� NCT ACCcP�Ci. <br />