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�� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32C0 CEDAR STREET, EVERETT,WA 98201,425-257-8810 <br /> cuw+...+Y� �•. � 9/r/�� <br /> SITE ADDRESS TARGF.L TAX LD.� PERMIT• <br /> SO/ u �z vs d�7S3�o �ov/ P� lb9 -O <br /> LEC3AL LOT NO. BLOCK TRACT <br /> DESC. f � <br /> OWNER � ADORHS �HONE <br /> �H�tzc�s t.4»�� iSs etS�-</Z <br /> TENANTNAME CONTACTNAYE `��'��� � PMWIE <br /> � /G�� �/.f5� S'�-/�// <br /> � �cron ���uCKe� G coHn+•ucEnsEr <br /> l�iG/C C�R�s /�. � '� <br /> PHONE ._ � �V �I- U NCl 'JSTN <br /> PROPOSED USE OF SUILDINfi �.�QGiI�rp (� M�ctunial Audltlm FIEAT EOURCE <br /> PERMIT D C�rtbMatlott D Pl�mb(np WCRK �iMntlon D Eroetric <br /> C TYPE D DemoNlat D sro� rrPe .�. l> a.. <br /> D Spri�M�r Rp�MA4tnt. L� OMr <br /> CONTRACT PRICE OF WORK � GTY Of EVEREITLOCAL 6AL�TA%CW[M 7106 <br /> WORK DESCRIPTION �U/�D �Z x ZZ CR�,� '�� s IT�" t���N � <br /> f}PPet�J�� ��.� Gri� e� C�11�Tr-� rnSTl'R«Jf'L- CD.Q�YttcNllSs(u <br /> /�{N'� JAR W NC�- LC�F�� . AAI/I �O � <br /> PLUMB�Na <br /> NO. TYPE OF FlIRUqE OR ITEM N0. TYPE OF A7fTUNH OR IiEM <br /> _ WATERCLOSET _ NC-NHANDL1NaUNfTS <br /> , BATHTUB _ FORCED AIR 3Y3TEMS <br /> _ LAVATORY(WASH BASIN) __ HEAT PUMP <br /> _ SHOWER % _ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSP.� .� _ CLOTHES DRYEfi <br /> DISHWASHER _ RANOE HOOD % <br /> IAUNDFY'TRAY _ WATER HEATER <br /> CLOTHES WASHER _ M�TAL FiREPIACE/ VE <br /> URINAL _ FlREPLACE INS <br /> ,_ DfiINKINa FOU AIN _ OAS F�REP <br /> FLOOR DRA1 _ (3AS RAN <br /> BACKFLO REVENiER � OAS PI 0 <br /> _ SINK(S= VICEfBAFUMOP/ETC.) _ ST FAN <br /> OTH _ ER <br /> _�_� _ <br /> { — <br /> �HEREBY CERITIFV THAT I HAVE RE>0 AND DUMINED TMIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ML <br /> PROVISIONS OF L4W6 AND ORIDINPCEg qOVERNIN6 THIS 7YPE OF WORK W1LL BE COMPIIED WITH WHETHER SPECIFIED MEREIN OR <br /> NOT. THE GRANTINO OF A PERMIT JOE3 NOT PRESUME TO 61VE AUTMOF;TY TO VIOLATE OR CANC0.THE PROV16iON OP ANY 7MER <br /> STATE OR LOCAI LAW REOULATNG CONSTRUCTON OR TME PERFORMANCE OF CONS?RUCTION. THAT I AM AUT}IORI�D BV THE <br /> OWNER Of THIS PROPERTY TO PEF FORM THE WORK FOR WMICM APPLICATION IB MAOE AND I COMPLY NRTH THE STATE <br /> CONT TORS LAW 18.27 RCW ANU 288200 WAC. <br /> , , .� D - - o P�� <br /> Si neture of wnedCoMrad utl,odzed Apant Data <br /> 1i7, � l <br />