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I � � <br /> P�r�MI� APPLICATIO�nI <br /> ��" CITY OF EVERETT PERIVIIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 . <br /> SITE ADDRESS ,/� PARCEL TAJ(I.D.8 PERMIT# <br /> 73 Z U' �ef Kr , e � c�3 s ��mo ora, c�/ 9 -a�Z <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS � PHONE <br /> f�u�ss ��s� S'�q_ Sy �- Z3o3 <br /> TENANTNAME CONTACTNAME Cef pHONE <br /> � I�i�n Lkp(��_I� ILo6.,387- oZ�'o <br /> CUNTRACTOR ADDRESS CONTR.LICENSEM <br /> C''14� k-�— �'r�S�14aa-�-,�-, �w / 04DY �1�����xcl�r'• I,,��LIL�GIOb�,�1V <br /> PHONE I3o�C�� , l�/L- Q gDf( <br /> PROPOSED USE OF BUILDING Building n Mechanical Addition HEAT SOURCE <br /> S� ��i&�� PERMIT �ombination � Plumbing WORK � Al�eraUon D Eiearic <br /> TYPE Demolition Sign TYPE Now D Gas <br /> Sprinkler RepairlMaint. D Other <br /> CONTRACT PRICE OF WORK ' — 6S Od D CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> WORK DESCRIPTION <br /> �i�e �-�-���.-f,�., � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TYpE OF FlXTURE OR ITEM <br /> WATER CLOSET _ A/C—A/HANDLING UNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUM? <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METAL FI9EPL4CE/STOVE <br /> URINAL _ FIREPLP:,E INSERT <br /> DRINKING FOUNTAIN _ GAS FIFiEPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER _ GAS PIP!";C <br /> SINK(SERVICElBAR/MOP/E7C.) _ EXHAUST FAN <br /> OTHER_ _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPL�ED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING UF A PERMIT DOES NOT PRESUPAE TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> S iATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COA4PLY WIT4 THE STATE <br /> C JNT CTORS LAW 18.27 RCW AND 296.200 WAC. <br /> ��>� g/zq o y <br /> Signature ol OwnedContracl / uthonzed Agent Date �?�Z�1 <br /> �i <br />