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PE�� �MIT APPLICATIO.� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADORESS PARCEL TAX I.D.M � PERMIT a <br /> 508 e,t'�ie E �o y 53 O 02�oO 20(0 -n� <br /> LEGA LOTNO. BLOCK TRACT <br /> oEs°. � o� � H �s FRsr �D o�L <br /> OWNER ADDRESS ZIP PHONE <br /> ../0�l,�1 F. ��c�c�l ,�So� iP�c A✓� E'v�,ecrr 9��oi ��2sY1sz-�'9�a <br /> . TENANT NA �h CONTACT NAME pHp <br /> j ( �Gtl�t(C2� I �OGt/�/GP� <br /> I CONTRACTOR AD�RESS ZIP CONTp.LICENSE N <br /> I <br /> � � <br /> PHONE <br /> � �i�tl/L�LJ <br /> PROPOSED USE OF BUILOING I Building f1 Mechanical Addiiion HEAT SOUPCE <br /> PERMIT � Combination �_� Plumbing IWORK � Aiiera�ion � Electric <br /> /� �y-� � 7YPE Dernolilion �� Sign 1YpE New Gas <br /> ' /`E`S�'���LC� Sprinkler RepairlMaini. Other <br /> � <br /> � CONTRACT PRICE OF WORK .y,� �g o bn�-5�i DO� CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> � WORK DESCRIPTION � <br /> ! <br /> �00�,�� 7 �S,F. ADvrno�t To �XrsnMG ZNa Fiafl2, <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR IT[M NO. TYPE OF FI7(TURE OR ITEM <br /> � WATER CLOSET _ A/C—A/HANDLING UNITS <br /> BATIiTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASIi BASIN) _ HEAT PUMP <br /> . __ SHOWER UNIT HEATEFS <br /> _ KITCHEN SINK 3 DISPOSAL _ CLOTHFS DRYER <br /> DISHWPSF!ER RANGE HOOD <br /> _ LAUNDHY fqAY WATER HEATEFi <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> : _ DRINKWG FOUNTAIN ,� GAS FIREPLACE <br /> ! _ FLOOR DRAIN GAS RANGE <br /> � BACKFLOW PREVENTER = GAS PIPING <br /> _ SINK (SEAVICE�BAR/MOPlETC.) � EXHAUST FAN <br /> � OTHER OTHER <br /> I MEREBY CERITIFY THAT I HAVE READ AN�EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF 1�1N'S AN�ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITN WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERh11T DOES NOT PRESUAIE TO GIVE AUTHO(iITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE GR IOCAL LAW REGULITING CONSTRUCTION OFi THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNE F THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COh7PLY WITH THE STATE <br /> CON AC ORS lAW 1 27 C�N AND 296200 WAC. <br /> t c�cUr�C ��/aZ <br /> Sign � ol Owner/Contr clor/Aulhorized Agen( Date II <br /> L <br /> '�5�� /TT/I�N�U <br />