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P �L-r�MIT APPLICATIG .J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.R PERMIT� <br /> �o y lNav�,R� oo y ,� o000 3 00 0�� - 00�7 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDFESS ZIP PMONE <br /> k,��., P��N � oy w�uE2�y �iaz�� zsz • 4o�y <br /> TENANT NAME CONTACT NAME PHONE <br /> 1`�'��l v�� Sl��� 3D3 �s� <br /> CONTRACTOR ADDRESS ZIP CONTR.IICENSE N <br /> V.a1J S LYc.� /�s•c�arr.s , �nr C . P.D.60� i3el,G E�,wo . �°a c� <br /> PHONE <br /> �� 30� 0�s(. �i4NS L�4Z D2l D � <br /> PROPOSED USE OF BUILDING I TMPE�T � Spnnkile�,n n � S 9n ti ngal ITMPE I--/ Repai%Maint I MEAt SOI heCE <br /> � .. <br /> U l ,� <br /> CONTRACT PRICE OF WORK � 1� �� CITV OF EVERETT LOCAL SALES TA%CO�E IS 3105 <br /> r <br /> WORK DESCRIPTON �_ <br /> �,.�C ��� ��a� e�--- <br /> `M.p`v ('a'�"`A� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl7(TURE OR ITEM N0. TVPE OF FIXTURE OH IT�M <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> � KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> i DISHWASHER � RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHEF METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN . _ GAS FIREPLACE <br /> � I _ PLOOR DRAIN _ GAS RANGE <br /> ! BACKFLOW PREVENTER GAS PIPING <br /> � SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> � <br /> I HEREBV CERITIFY THAT I HAVE FEAD AND E%AMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPUED WITH WHETHER$PECIFIED HEREIN OR <br /> NOT. TNE GRANTING OF A PERMIT DO 5 NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PFOVISION OF ANY OTHER <br /> STATE OR LOC.1L LAW-R LATING NS UCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHOFIZED BY THE <br /> OWNER OF THIS PROP T P FO HE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> � CONTRACTORS-� 8�7 R ND 200� <br /> � � f��T QT Z�. oz_ <br /> Signature ol Owner onlract Authorized Agent Date <br />