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(�ERMIT APPLICA�-:ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-9857 <br /> SITE ADORESS / 9a 8 Gt�� ��'� �"' PARCEL TAJ(I.D.N PERMIT� <br /> c',�e�� u �- o - 7 - o r 8_ z � o3r� � -c,dc� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PMONE <br /> �eir „�n�H ro+� �9a� GJc�mo� h-�- 'dZ�l <br /> TENANTNAME I CONTACTNAME PMONE <br /> °l�s 3�15- 9s�� <br /> CONTRACTOR ` \ r ADDRESS I _ e LP CO .LJCENSE♦ <br /> S'tto�t oNtf C �fm.x1� � / ;�,\\�" cS W�laH �iJ S{u� L�r o16 ►��' <br /> PHONE 5Ki7t vi S•tU hfi �V��4��"� G.��- '�21� <br /> PROPOSED USE OF BUILDING Building � MeChBnical I AdOilion NEAT SOURCE <br /> I PERMIT �mhination Plumbing WORK B Alteration � Electric <br /> IYPE emolition Sign IYPE D New Gas <br /> Spnnkler U FapairRdaint OMer <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX COOE IS 7105 <br /> WOHKDESCRIP710N /�Gvy�uli ,b"+ aY l�d�ta�'L S "� `'�✓�"`r <br /> �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM N0. TVPE OF FlXTURE OR tTEM <br /> __ WATER CLOSET NC-AMANDLING UNITS <br /> ' BATHTUB FORCED AIR SYSTEMS <br /> _ I.AVATORY (WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 OISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> CL9THES WASHEii METAI FIREPLACE/STOVE <br /> i = URINAL = FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> ! BACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> � OTHEA _ OTHER <br /> I HEREBV CERITIFV THAT I I1AVE READ AND EXAM�NED THIS APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WURK WILL BE COMPLIE�WITM WHE7HER SPECIFiED HEREIN OR <br /> NOT. THE CaRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOWTE OR CANCEL TNE PHOVISION OF ANY OTMER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TMAT I AM AU7HORIZED BV THE <br /> OWN[R OF THIS PROPERN TO PERFORM THE WOFK FOR WHICH APPIICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND.96 200 WAC. <br /> S'��� `��� >,1�/-,-�- <br /> Signature ol Owner/CoNractor/Authonzed Agent Date <br />