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�— PERMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201, 425-257-8810 <br /> SITE ADDRESS pARCEL TAX I.D.• PERMIT N <br /> aoo9 �,Je�-�►�re ooy 3 oos oo ZU3 ��/ <br /> LEGA� LOTNO. BLOCK TRACT y� <br /> DESC. 5 � � r `1 j)IUI <br /> OWNER ADORESS IpHONE <br /> Yl�.y YI�J rD hV , aoo�'i W��w►o r{ � e15a- yb 13 <br /> TENANT AME CONTACT NAME PHONE <br /> �(lary ►'�I��Q�y I hllike I.u.rs�,v► I d59- �173 <br /> CONTRACTOR / � ADDRESS � CONTR.LICENSE• <br /> /-.AI"Sf11 COYISt <br /> PHONE �S 3,��— d535 � 31D l�Jerym ;8�( �jC��{(- I�1IRSEG � 101OH <br /> PROPOSED USE OF BUILDING Building � Mechanical nqddition HEAT SOURCE <br /> � PERMR � Cambination Pl9mbing WORK � Altaretbn � Electric <br /> f.�5� f� TYPE Demolition Si n TYPE New Gas <br /> Sprinkler RepairRAa�nt. OTher <br /> CONTRACT PRICE OF WORK � �j � O a CITY OF EVERETT IOCAL SALES TAX CODE IS�105 <br /> WORK DESCRIPTION ����/,Lnn t f �* <br /> �r� � � rcmo�i.� � rkw b„i� <br /> Qnrc h <br /> MBI (i MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM N0. TYPE OF FlXTURE OR REM <br /> � X WATER CLOSET A/C—A/HANDLING UNITS <br /> I� BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> ( _� SHOWER UNIT HEATERS <br /> J_ KITCHEN SINK 8 DIBPOSAL CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATEfi HEATER <br /> � CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ �AS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOPlETC) � EXHAUST FAN <br /> _ OTHER OTHER <br /> _ � <br /> — — i <br /> — — � <br /> I HEREBV CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNO�V THE SAME TO BE TRUE AND CORRECT. ALL � <br /> PROVISIONS OF LP.WS AND ORI�INACES GOVERNING TH�S TVPE OF WOHK WILL BE COMPLIED WITH WHETMER SPECIFIED MEREIN OR � <br /> NOT. THE GfiANT�NG OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOL4TE OF CANCEL THE PROVISION OF ANV OTHER � <br /> STATE OR LOCAL LAW REGULATING CONSTAUCTION OR THE PERFOFMANCE OF CONSTRUCTIOM THAT I AM AUTHORIZED BY THF_ ; <br /> OWNEF OF THIS PROPEFTV TO PERFOFiM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITM THE STATE <br /> CUNTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> ;�y'�e���S� 3-�a-o 2 � <br /> Signature of Owner/Conlractor/Authonzed Agent Date <br /> ,3� . G - <br /> ��� <br />