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�.'ERMIT APPLICA� �ON � <br /> CITi' OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425•257-8857 � <br /> � p�.J oa�a a55 <br /> S�TE ADDRESS �,rt��J PARCEL TAX I.D.M <br /> F�JO/ PERMIT M <br /> ^r �o r. CX� 3 / -Cx�o -v��- coai�,-op <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. �� �G� t / � <br /> OW ER Q (�UN�.nJS ' �I4�vt` G.��i.�� S � I � � <br /> � e� ' / ADDRESS LP PFiONE <br /> -K���-� S l . / yr s- <br /> C�- 7��. � � r ��r 1 ZS � <br /> ANTNAME I � X 'K � �� '�� � c� u <br /> NTACT NAME <br /> / c �n�jr,� � PHONE � <br /> (�! r (-1 Mf ,1 I � V' (�(' r�l�� <br /> CONTRACTOR ADORESS <br /> LP CONTR.LICENSE N <br /> PHONE <br /> PROP05EDUSEOFBUILOING I Building (1 Mechanical Addition MEATSOURCE <br /> PERMIT Combinalion � plumbing WOqK R�/ Altaration Electric <br /> � �C r� af ��'�Z TYPE �DemoliHon Ll Sign TYpE �J New R�( Gas <br /> (�� �� �prinkler U RapaidMaint. U Olher <br /> CONTRAC7 PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPT70N <br /> . �� � � , � � � � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TYpE OF fl%TURE OR REM � <br /> WATER CLOSET A/C-NHANDLING UNI7S <br /> � BATHTUB I FORCED AIR SYSTEMS <br /> I _ LAVATORY(WASH BASIN) _ HEAT PUMP � <br /> SHOWER UNIT HEATERS <br /> i T KITCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> � DISHWASHEF � <br /> _ LAUNDRY TRAY RANGE HOOD <br /> � CLOTHE5 WASHER � H'ATER HEATER <br /> � _ URINAL — METAL FIREPIACE/STOVE <br /> _ DRINKING FOUNTAIN PIREPLACE INSERT <br /> _ FLOOR DRAIN � GAS FIREPLACE <br /> _ BACKFLOW PREVENTER T GASRANGE <br /> _ SINK(SERVICE/BAR/MOP/ETC.) � GAS PIPING <br /> _ OTHER EXHAUSTFAN <br /> _ OTHER <br /> I HEPEBY CERITIFY THAT I HAVE Fi61D AND EXAMINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L.AWS AND ORI�INACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> N07. THE GRAN7ING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br /> S7ATE OR LOCdi f.AW UTA7ING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THqT i AM AUTNORIZED BY THE <br /> OWNER OF THIS P PER O PERFORM THE WORK FOR WliICH APP ATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORSLAW 1827 R W AND 2 .2 WpC. <br /> � Z S� /LL <br /> Signature o riContr ctodA o rzed Age Date � <br /> .�� 3' `�v <br />