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F��RMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> P� �(a - O�--c�i <br /> r <br /> SITE ADDRESS PARCEL TAX I.D.R PERMiT• <br /> s t� a�l •e.R ve. F�Qo �F3 � - o00- o o-� oo -o��-�o�.� <br /> IEGA LOT NO. ��pT BLOCK TRACT <br /> DESC. t �', S 00 — � <br /> OWNER ADDRESS LP PMONE . <br /> ��2 E�n�0.dGa�es. l-.l.•C l'lb3a�3s Aue�, _ �_ `ti�dbl� �ya.s' •'1y3�1114 <br /> TENANTNAME I CONTACTNAME PHONE <br /> �yu �-cssl� �las -��13�����f <br /> CO ACTOR , ADDR S ZIP CONTR.UCENSE M <br /> �0� ��P�s'��' ��'� ' �?c�3a- 3ti�AJv_SE 4401�. AD(a�QL+ V03dt1 <br /> PHONE <br /> �as - -iti3- ���� ` <br /> PROPOSEDUSEOFBUILDING I�'�uilding rJYMechanical Addition � MEATSOUHCE <br /> I ���`,,�� � � PERMIT n Combinetion ��lumbing IWORK �Alteretbn �tectric <br /> e"—'- \ —_ , _� TYPE ❑ Demolition �J Sign TYPE Naw I as <br /> � vu_uJ,c"Y�„vT �� Sprinkler RepairlMainL Other <br /> ICONTRACT PHICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS�705 <br /> WOHK DESCRIPTION <br /> ' ti1�•�.� �lcw�aa lre.�lo.�-s;� aUoc� <br /> � <br /> I I <br /> IPLUMBING MECHANICAL <br /> i NO. TYPE OF FlXTURE OR REM N0. TYPE OF flXTURE OR ITEM <br /> � _� WATER CLOSET A/C—AMANDLING UNITS <br /> (_ BATHTUB � FORCED AIR SYSTEMS <br /> � �-I LAVATORY(WASH BASIN) _ HEAT PUMP <br /> � SHOWEFl ,_ UNIT HEATERS <br /> � � KITCNEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> : l DISHWASHER �_ RANGE HOOD <br /> LAUNDRYTRAY � WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> � _ URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN � GAS FIREPLACE <br /> _ FLOOR DRAIN � GAS HAN(3E <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOPlETC.) 3 EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFI THAT I HAVE RFAD AND E%AMINED THIS APPLICATION APID KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br /> PROVISIONS OF U1W5 AN�ORIDINACES GOVEPNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEFi SPECIFIED HEREIN OH <br /> NOT. 7HE GRANTING OF A PEFMIT DOES NOT P�ESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> S7ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE;CAFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWMEF OF THIS PROPERTV TO PERFORM THE WORK'Jrt WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CO RACTORS LAW 78.27 RCW AND 296.200 WAC. <br /> �„ o ,��w. ,�� � �\ a�1o,- � <br /> Signalu e of Owner/Cont ct dAuthorized A ent Deta ` ,I� <br />