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P I�MIT APPLICATIO� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320U CEDAR STREET, EVERETT, WA 98201,425-257-8810 <br /> SITE ADDRESS PARCEL TAX I.D.• PERMIT A <br /> ��19 R�cu� �v�2.�,-r v+'A q5 i f�o�aq-o2y <br /> LEGAL LOT NO. BLOCK TF.4CT <br /> DESC. <br /> OWNER ADDRESS PHONE 1s�_ �Ips <br /> �' (;c h��►2E'f" ��(�i Ru�f� '�(L Yzs 'wM- <br /> STENANTNAME CONTACTNAME PHONE <br /> ��T H i EiZS 'P,� M r� y2-T• �� 09�1� <br /> CONTRACTOR ADDRESS CONTR. LICENSEA <br /> fou25EA�c.'r�S RooG�R�o��Z lr.t, Ic��i AJG v �A 325" <br /> PHONE ��S'38g -�Db SJOHOHig�} Wk q52�o �uL5Q5�1(�A <br /> PROPOSED USE OF BUILDING Building � Mechanicel qdditbn HEAT SOURCE <br /> PERMIT R Combinatlon Plumbing WORK B Attention D E�ectric <br /> .R��������_ TYPE D Demoliqon Sign TYPE D New L] c3as <br /> U Spdnkler 1...) RspaidMaln� U Omer <br /> CONTRACT PRICE OF WORK CITV OF EVERE7T LOCAL 9ALE3 TAX CODE IS�705 <br /> WORK DESCRIPTION <br /> "1"EArLDFf�STi^��T �L-A� "RA�FINL-i �'T��� KsSrtK-t, �ItrJ Tb2.CN DOY+�� RooF �N4' . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR fTEM N0. TYPE OF fll(TURE OR ITEM <br /> WATER CLOSET A/C—AMANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK F.DISPOSAL _ CIOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> DRINKING FOUNTA�N GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> dACKFLOW PREVEN'CER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFV THAT I HAVE AEAD AND EXAMINE�THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS AND ORIDINACES GOVERNING THIS TVFE OF WORK WILL BE COMPLIED WITFi WHETHER SPECIFIED MEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION Of ANY OTHER <br /> STATE OF LOCAL LA6V FEGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br /> OWNER OF THIS PROPERN TO PERFOR�d THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> �/111L(M— � �i�u�-�--� q'��-ol <br /> �nature of OwnedContractor/Authorized Agent Date <br />