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( t�. <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX425-257-8857 /[Of/0 —OD,� <br /> SITE ADDRESS PARCE�TAX I.D.� PEHMIT• <br /> 3zol �* '� c ��� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> —� E ��e� CONTACT NAME ,y PHONE <br /> TENANT NAME I 171/A� SMl1 �l \ 2 <br /> GR�2er 'L2n�ar \�'�Zs)J��'O�Z� _ <br /> CONTRACTOR ADDRESS �/ r ZIP CONTR.LICENSE 1 <br /> �u�Js Fire SyyfCnr, ��/� P. 6�L�x I ►0n q �j�RNSF�SvzYo3 <br /> PHOIJE � �g!/^ D�� Gf�n�ft f A����R -I��.S� lM <br /> k2S „ <br /> PRO�OSED USE OF BUILDING �Building MBCheniCel Addilion HEAT SOUKCE <br /> .���r,y���lC✓�p���a� (tftl�SPltdll pERM1T COmbinBliOn R�.( Plumbing WORK Atlarelion R Eleclric <br /> TYPE Detnolilio� U Slgrl TYPE Mew K 48g <br /> Sprinkler Repeir/Malnl. IJ Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS�106 <br /> WOHK DESCRIPTION <br /> 37-J .� �- <br /> ' PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM NO. � TYPE OF FlI(TUHE OR�TEM <br /> WATERCLOSET _ NC–A/HANDLINGUNITS <br /> B�THTUB _ FORCED AIR SYSTEMS <br /> LAVATUFY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS <br /> KITCI�iEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ `NATER HEATER <br /> CLOTNES WASHER _ METAL FIREPLACE/STOVE <br /> URINA� _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS F�REPIACE <br /> FLOOR DRAIN _ GAS RANGE <br /> 6ACKFLOW PREVENTER _ GAS PIPING <br /> SINK(SERVICE/8AR/MOP'ETC.) _ EXHAUST FAN <br /> OTfiER _ OTHER <br /> �I1[f7[OV CERITIf-Y TIiAT I 11AVE READ AND EXAMINED TIiIS APPLICATION AND KNOW fHE SAMF.TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IJ�WS AND ORIDINAC[S GOVEFNING THIS NPE OF WORK WILI BE COMPLIED WiTH WHETHER SPECIFIED HEREIN OR <br /> NOL THE Gf1ANTING OF A PEfiM1T OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> ST�Tc O�7 LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTIlUCTION. THAT I AM AUTHORIZEU BY THE <br /> OVJNER Of 7111S PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH TI1E STATE <br /> CONTRACTORS LAW 1827 RCW�ND 29G200 WAC. <br /> SignaWre ol OwnedConlraclodAulhorized Agent Dale /Z � <br />