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�,�}�. ERMIT APPLICAT �JN <br /> ��_ CITY OF EVERETT PERMIT SERVICES <br /> MrOF�TT 3200 CEDAR STREET, EVERETT, WA 98201 <br /> �/ <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.fF PERMI7 a <br /> l2�'S �2 �. 1«� f��E �U� <br /> LEGA LOTNO. BLOCK TRACT <br /> oesc. 13 � 1'`� ZZ�- I <br /> OWNEF ADORESS ZIP PHONE <br /> �,-�,��.t��� `"Cd�.�.a.ds �ZoS �,��.�e.a, �J�nv� 96Lo � �yz5�259 •9��I i <br /> TENANT NAME <br /> CONTACTNAME PHONE <br /> ICONTRACTOR ADDRESS ZIP CONTR.UCENSE M <br /> I <br /> IPHONE � <br /> I PROP05ED USE OF BUILDING Building Mechanical Addnion HEAT SOURCE <br /> PERMIT Combinalion �Plumbing WORK�Alteration �Electric <br /> I �j�ro,1� �a�''"�`� TYPE Demolilion Sign TYPE New Gas <br /> I (LL5 �C`�� �`G' L— Sprinkler RepairR.la�N. Other <br /> CONTRACT PRICE OF WORK LS'T, �R�CL O� ��u �P, zI CITY OF EVERETT LOCAL SALES TAX LO�E IS 3705 —_ <br /> �I WORK DESCRiPTION <br /> �ngro--\\ ��¢_�o_cL� � e.�a�E� hEJaTt2 � 20�� � C�2u�te-_ <br /> J <br /> I �j W�-r c 4. .r� � �= �o r� �.\4 C"T 2 �c. T o qas <br /> ...J <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR iTERl <br /> WATER CLOSET AJC-AiHANDLING UNITS i <br /> BATHTUB .J_ FOFCED AIR SYSTEMS <br /> I _ LAVATORY (WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> I KITCHEN SINK d DISPOSAL �_ CLOTHES DAYER <br /> DISHWASHER <br /> LAUNDRY TRAY �_ WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACEISTOVE <br /> I URINAI _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPL;CE <br /> FLOOR DRPIN �_ GAS RANGE <br /> BACKFLOW PREVENTEfi �_ GAS PIPING <br /> � SINK�SERVICEiBA(3/MOP/ETC.) _ EXHAUST FAN <br /> i _ OiHER _ _ OTHER <br /> i <br /> I HEFEBV CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND COPRECT. AlL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WCRK WILL BE COIdPLIED WITH N'HETHER SPECIFIED HEREIN OR <br /> ^70T. THE GRANTING OP A PER611T�OES NOT PRESUAIE TO GIVE AUTHORITY TO VIOL4TE OP CANCEL THE PROVISION OF ANY OTHER <br /> STATE JR LOCAL LAW FEGUTATING CONSTRUCTION OR THE PERFORM1IANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> CWNE9 OF THIS PFOPERT!TO PERFORM THE WORK fOR WHICH APPLICATION IS h1ADE AND I GCMPLY WITH THE STATE <br /> CONT9ACTORS LAW 18.27 RGW AND 2962C0 WAC. <br /> ���('01^ �-L � 12�LCo�d Z <br /> Sig ature o� OwneuContractorlAuthonzed Agent / � uate <br /> ( <br />