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PERMIT APPLICATION <br />CITY OF EVERETi' PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 <br />SITE ADDRESS <br />g3� - , MoM,� <br />LEGAL LOT NO. BLOCK <br />DESC. <br />OWNE�R <br />I--JDr+MSO� <br />TENANTNAME <br />�o„�� <br />HACiOs— <br />�i'/"'44� �O /r./C <br />PHONEZv� _ ��0 —�d7� <br />PROPOSED USE OF BUILDING <br />PERMIT <br />`✓.,�, TYPE <br />�r�L <br />CONTRACT PRICE OF WORK <br />WORK UESCRIPTION <br />PLUM8ING <br />NO. � TYPE OF flXTURE OR REM <br />WATER CLOSET <br />BATHTUB <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK & DISPOSAL <br />DISHWASHER <br />LAUNDRYTRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />� BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />PARCEL TAX I.D. N <br />Olio—DoJ <br />Pf10NE <br />CONTACTNAME <br />PHONE <br />ADDRESS CONTR. LICENSe R 3 <br />� G710 LRKSc ��y Gc�4`r N�4 �A�MAS " o`b <br />S,.-m�+-�a G�s� 9e'/�' C�- <br />n Bullding DMechenicel Additian HEAT SOURCE <br />�"'1 Combinallon U Plumbing WORK R Altere�fon D Electric <br />r-� Demolilion [� Sign TYPE D New D Gas <br />D Sprinkler �� RapeidMaint. U ome� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />NO. I TYPE OF fll(TURE OR ITEM <br />A/C — A/HANDLING UNITS <br />FORCED AIR SYSTEMS <br />HEAT PUMP <br />UNIT HEATERS <br />CLOTHES DRYER <br />RANGEHOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUSTFAN <br />OTHER <br />1 HEREBV CERIT�FY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TflUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A P MIT OOES NOT PRESUME TO OIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR IOCA 4V TING CONSTRUCTION Oii THE PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUTHORIZED BY THE <br />OWNER OF T TO PERFORM THE WORK FOR WHICH APPLICqTIp� IS MADE AND I COMPLY WITH THE STATE <br />CONTRA AN�96200 WAC. // // <br />�(//// �/ ' <br />