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PE� �MIT APPLICATI4.i I <br /> � CITY OF EVERETT PERMIT SEFiVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810- FAX 425•257-8857 <br /> � —/}-02 <br /> � SITE ADDRESS PARCEL TAX I.D.a PERMIT a <br /> � Cv I � vi P�il R; D��� m4Co�-1 oco os4o i �_ ,; �-G � <br /> LEGA LOT NO. 2 BLOCK TRACT <br /> DESC. 5�? 1201'3'f'78 <br /> OWNEH ADORESS ZIP PHONE <br /> Pav� rr�Ke� Co �"T vr�.v (�;dqe Or;�c, R�?o3 q-1�-z5�-258� i <br /> T[NANT NAh7E CONTACT NA1d8 PHONE <br /> CON?RACTOR ���G ADDRESS ZIP CONTR.LICENSE N I <br /> PHONE �a.�G <br /> I — <br /> , PROPOSFD USE OF BJILDING � Bwlding MechaniCal Addilion HEATSOURCE <br /> PERMIT Combinalion R Plumbiny WURK Allcration Electnc <br /> , L�YJ _ r�ri OMm TYPE �Demolition p Sign ll'PE New � G�s <br /> J F-• f^Gv f'w Spnnkler Repairihlainl. Other j <br /> � CONTRACT PRICE OF WORK �� ;j j � ' — CITY OF EVERETI'LOCAL S.1LES TAx COOE IS 3105 <br /> I WORKOESCRIPTIOIJ �nGld� d�i�--� �� �I�Till'�9 y�gc, - t-�pia� s�di✓IQ <br /> � on en�irG ho�se. J <br /> I <br /> , PLUMBING MECHANICAL <br /> I NO. TYPE OF FI7CTURE OR ITEh7 N0. TYPE OF FIXTURE OF ITEM <br /> N;ATEF CLOSET A/C -A/HANDLING UNITS <br /> BATHTU6 FORCED AIR SYSTEMS <br /> LAVATORY(WASf'BASIN) ^ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK& DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATEF HEATER <br /> CLO�HES WASHER METALFIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSEFT i <br /> _ DRINKING FOUNTAIN GAS FIREPLACE � <br /> _ FLOOR ORAIN GAS RANGE I <br /> BACKfLOW PREVENTER GAS PIPING <br /> 1 SINK (SERVICEi0AR/MOP/ETC.) EXHAUST FAN ' <br /> OTHER OTHER <br /> — — I <br /> � <br /> I HEFEBY CERITIFV'HAT I HAVE PEAD AND EXAMWED THIS APPUCATION AND KNOW THE SA1dE TO BE TRUE AND COFRECT. ALL � <br /> PROVISIONS OF L4WS AND ORIDINACES GOVEPNING THI6 TYPE OF'rVOflK WILL BE COPdPLIED LVITH WHETHER SPECIFIED HEREIN OR i <br /> NOT THE GRANTING OF A PERh11T DOES NOT PRESUME TC 91VE AUTHORIN TO VIOI.ATE OR CANCEL TNE PROVISION OF ANY OTHER I <br /> 5 i ATE O(i LOCAL LAW REGULITING CONSTNUCTION Of9 THE PEPFORMANCE OF CONSTRUCTICN. THAT I Ald AUTHORIZED BY iHE � <br /> OWNER OF THIS PROPEFTY TO PERFORM THE WORK FOR WHICH APPLICATION IS t.1ADE AP�D I COh1PLY INITH THE STATE � <br /> CONTRAC' S LAIV 1827 RC�N AND:06.�00 WAQ M I <br /> -���� l �� L ��� �VL <br /> Signature ol OwneuContractodAuthonzed Agenl Date <br /> IZ � <br />