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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32C0 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE AUDRESS PARCEL TAX I.D.N PERMIT M <br /> 3ou7 vrcTo2 �L . <br /> LEGAL LOT NO. BLOCK TRAC7 <br /> DESC. <br /> OWNER ADDRESS �5.�3 �y� �,UF #z�l PHONE <br /> ��Nv��D C. Si,Z'e vD SEaiT�E wp . 98� � z � 3z3 - �/Z (�S <br /> TENANTNAME CONTACTNAME I PHONE <br /> �vN S"Jf1 t U i, <br /> CONTRACTOR � ADDRESS ( CONTR. LICENSEN <br /> �o�v STi�' s v.D /� d n v �' <br /> PHONE <br /> /9BO U E <br /> PROPOSED USE OF BUILDING [�'�uilding � Mechanicel Addition HEAT SGURCE <br /> /� � PERMIT Q Combinalion Plumbing WORK Alteratbn Electric <br /> (` � `J � TYPE �y^Jemolition Sign TVFE New � Gas <br /> LJ Sprinkler epalrM!alnt. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS]f05 <br /> WORKDESCRIPTION '��yy�p�,i3H G�����/'�^�L'/ <br /> /ZclNfGt2�� Frvn4071c�-� in Qn�FA <br /> DATL�-r ELcaZ�2oof w�M S�n,�urL Co,-r�-nzuc��ch <br /> PLyMBINO ME1CHANI�AL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH 6ASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACFJSTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNI'AIN GAS FIREPLACE <br /> FLOOF DRAIN GAS RANGE <br /> BACKFLOW PREV[NTER GAS PIPING <br /> SINK(S[RVICElBAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER __ <br /> I HEREBV CERITIFY THAT I HAVE READ�ND EXAMINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS ANO ORIDINACES GOVERNING�fHIS NPE OF WORK WILL BE COMPLIED WITIi WHETHEF SPECIfIED I1EFiEIN OA <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE PROV!SION OF ANY OTHER <br /> STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTI0IJ. THAT 1 AM AUTHOR�ZED BY THE <br />" OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR VJHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CON ACTORS LAW 18.27 R AND ,2710 AC. <br /> ��� �. �-�z�. �iz , /��d , <br /> Signalure oi Owner/ onlracte4Aulho � d Agent Date <br />