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( i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320G CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D,i PERMIi p <br /> 51Z1 3e�h �' RU� oo�-flLel�oaaooCea� �no3ii-�r3 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS �p pM N <br /> '�� '� � �4 Yki►c� SIZf cflvrt l f4tJ� 3 `�2S 2SY'i 3G9S <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> I �'A-►�(cP �i.�(4 fl,�o� �G 2-82SQldo ' <br /> CONTRACTOR �� ADDRESS LP CONTR.U�ENSEM <br /> �-c�FtSf'I L y .�"'� <br /> �o�e 282 c��0o`ttlornd�.. �1�15 G/A�Gt/�1 y�/o� <br /> PROPOSED USE OF BUI DING f'� Building f�MeChanit2l n�ACtlilion XERTSOURCE <br /> PERMI7 K ComMnadon H Plumbing WORK �Lllerollon �kctne <br /> TYPE F.� Domolltion IJ SI9n TVPF D Naw p, <br /> LI Spdnkler U RepaiNMalnt. I 01her <br /> CONTRACT PRICE OF W RK �^"7�I � �� CRV OF EVERETT LOCAL SALES TAX CODE IS�795 <br /> ! <br /> WORK DESCRIPTON . — <br /> ��115 IlI+1S �f `-�urYl�.ce �#� lfo,o�o h�+J) <br /> wlg�r ��P�n �� � <br /> PLUM9ING MECHANICAL <br /> NO. TYPE OF FIl(T RE OR ITEM NO. TYPE OF FIXiURE OR ITEM <br /> _ WATER CLOSE (TOILEn AP�-NHANDLINC UNITS <br /> _ BATHTUB � FORCED AIR SYSTEMS <br /> _ LAVATORY(WA H BASIN) _ HEAT PUMP <br /> _ SHOWER UNITFiEATERS <br /> _ KITCHEN SINK �ISPOSAL _� CLOTHES DRYER <br /> = UISHWASHER =I RANGE HOOD <br /> LAUNDRYTRAY VJATER NEATER <br /> __ CIOTHES WAS ER _ METAL FIREPlACE/Si OVE <br /> __ URINAL FiREPLACE INSERT <br /> _ DRINKING FOU TAIN GAS fIREPLAI:E <br /> _ FLOOR DRAIN GAS RANGE <br /> _ BACKF!OW PR ENTER � GAS PIPING <br /> _ SINK(SERVICE/ AR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER � OTHER <br /> I HERE6Y CERITIFY THA I HAVE REAO AND EXAMINE�TNIS MPLICATION AND KNOW TFiE SAME TO Bt TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS A D ORIDINACES GOVERNI�G THIS TYPE OF WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. 7HE GRANTING OF A PERMIT OOES NO7 aRESUME TO G:VE AUTHORITV TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL lAW R GULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY 7HE <br /> OW NER UF THIS PROPE TY TO PERFORAI TME W ORK FOR WMICM APPLIGATION IS F�MDE AND I COMPLY WITM THE STATE <br /> CONTRf�GTORS 18. 7 RCW AND 196.200 WA (I���!`� <br /> 9 m� `i 577�-��� (J <br /> S ur of Owner/C n acror/A onze ge t Date <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> T'd �SBBLS�bS�01 �W02f� LS�£T E002-S-f1M <br />