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— � <br /> v <br /> PERMIT APPLICATIC3{N <br /> �. CITY OF EVERETT PERMIT SERVICES <br /> �1"' 3200 CEDAR STRE�T, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857 <br /> I�o/!O - oo(o <br /> SITE ADDRESS PARCEL TAl(I.D.8 I PERMI� <br /> �zol �n�th � �-��� <br /> LEGA LOT NO. BL(?CK TRACT <br /> DESC. <br /> OWNER AD�RESS LP PHONE <br /> . E�: <br /> TEN\Nl NAME CONTACT NAME MN AI'�h L. PHONE <br /> �i�wcu�iCl, CCnfEJ' I �uRA�S Fi rc S��rhs,r1l/c ��2� 3�D124 <br /> CONTRACTOR 8u�� Fj� Sy�`���L ADDRESS ZIP CONTR.UCENBE 11 <br /> �?D� �ox nro �IRII�SF�024�3 <br /> PHONE /�f�.\ �10�1�'j4y C���l� F41/s, h/A 9P�SL <br /> L� J <br /> PROPOSED USE OF BUILqNG Building MechenMsl AddHbn HEA!SOURCE <br /> ���N�-�{�� �1 (eh�� y�ItcP PERMIT R Cambinelion R Plumbing WORK R Alterelbn � Eleciric <br /> TYPE ��Demolilion D Sign TYPE R New Oea <br /> Jci Sprinkler V pepalr/Mainl. Olher <br /> CONTRACT PRICE OF WORK CfTY OF EVERETT LOCAL SALEB TAX CODE 18�106 <br /> WOHK DESCRIPTION "T'Z /.,, � �y. ,�46t 1� � <br /> '-... <br /> �z� DD-w, . .we �rl/� <br /> PLUMBING f MECMANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLINl3 UNITS <br /> BATHTUB FORCED AIH SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> K�TCHEN SINK&DISPOSAL CLOTHES DRYER <br /> D�SHWASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN _ (iA5 HANOE <br /> BACKFLOW PREVENTER dAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> OTH[R _ OTHER <br /> I HEREBY CERITIFV THAT I NAVE HEAD AND ERAMINED THIS APPUCATIGN AND KNOW THE SAME TO BE TRUE AND CORHEC?. ALL <br /> PROVISIONS OF IJ�WS AND ORIDINACES GOVERNING tH15 NPE OF WJRK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NUT. 7HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AU'HORITY TO VIOLATE OR CANCEL THE PHOVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFO'iMANCE OF CONSTRUCTION. THAT I AM AUTHURI2ED BY THE <br /> OWNER OF TIilS PROPERTV TO PERFORM THE WORK FOR WHICH AFPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296200 WAC. <br /> �to�, �,a„� lp,�zz/D I <br /> Signatur ol OwnerlConiraclor/Authorized Agent Date �/ <br />