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PE�MIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N aERM u <br /> �S 1'1 8MttE4 M! 5' o0 5��00 au, oco - � <br /> LEGA LOT N0. BLOCK TRACT <br /> oesc. 2,(0 �J . 3�t�168 '�'eLTs <br /> OWNER ADDRESS ZIP PHONE <br /> ebN Y�' aBt� �nn��n�t av�u� ��2o I 4zs-?,6'q-9�8 <br /> TENANTNAME CONTACTNAME PHONE <br /> - �7fEU. MA�NU�K�AWNf� I DA�R�b'k- GLB�.i.l /+?��?.b�"�A�oB <br /> CONTRACTOR ADDRE55 21P CONTH.LICENSE N <br /> NtanlW�� GoNbtW�lcxtoN aaoo c�k�o�l�lut- CtRsirt992o1 NQrJL.AG�343/.0 <br /> P�l�N25-�9-9 �9 l <br /> PROPOSEO USE OF BUILOING I Building (((��� Alechanical Addi�ion HEAT SOURCE <br /> �n.�Wv�er PERMIT �Combina�ion I ) Plumbing IWORK g Alteralion � Electric <br /> re�y�,�vb/��6� TYPE Demolilion d Sign 7YpE D New I Gas <br /> Sprinkler U Repair/MeinL Olher <br /> CONTRACT PRICE OF WORK 'GT���O CITY OF EVEP.ETT LOCAL SALES TAX COOE IS 3105 <br /> VV <br /> WORK DESCRIPTION <br /> �4 1��8'1 SQ.�r: ��mcrJ � w�lw�s�/��� �acg <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FIXTURE OR ITEh1 N0. TYPE OF FIXTURE OR IT[M <br /> _ WATER CLOSET _ A/C—A/HANDLING UNITS <br /> _ BATHTUB FORCED AIR SYSTEMS <br /> _ �AVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNITHEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CIOTHES DRYER <br /> _ DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> I _ URINAL _ FIREPLACE INSERT <br /> i = DRINKWG FOUNTAW _ GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> i _ BACKFLOW PREVENTER _ GAS PiPING <br /> i _ SINK(SERVICE/BAR/MOP/ETC J _ EXHAUST FAN <br /> ( _ OTHEF _ OTHER <br /> i — — — <br /> i — <br /> ' I HEREBY CERITIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. AI.L <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS 1YPE OF WORK WILL BE COMP�IED WITH WHETHER SPECIFIED HEFEIN OR <br /> NOT. THE GR.�NTING OF A PEPMIT DOES NOT PRESUME TO GIVE AUTHOPITV TO VIOLATE OR CANCEL THE PfiOV�510N OF ANY OTHER <br /> STATE OR LOGAL LAW REGULATING CONSTRUCTION OR THE PEPFORMANCE OF CONSTRUCTION. THAT I AM AlJ7HOR12ED BY THE <br /> �. OWNER OF THIS PFOPEFTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> I CONTf TORS LAW 18.27 R W AND 296.200 WAC. <br /> I <br /> i ^ , <br /> � Sign Pwner/ Au h nzed Agent Data �j <br /> � a <br />