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�'ERMIT APPLICA�'JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> — N1oar�-6� � <br /> SITE ADDRESS E'v�.c1T Ca'r�tunj+y !aV"ga- ppRCEL TN(I.D.k PERMiT w <br /> or?tX�O S� . {11�2r21�- �'�l <br /> LEGA LOiNO. BLOCK TRACT <br /> OESC. <br /> OWNER ADDRESS ZIP PHONE 3�- 0� S <br /> �cQ� • oF 6anera� I�dm�n'�s4r0.+,� � P�`� �l��iz ��� �85o�-itxL <br /> TEN1 NT NAME ONTACT NAME PNONE <br /> 5h�ks��-v, -��t�I � �c��.tn �a_.t,(_ �/zs-33�(-35z� <br /> CONTRACTOR (�r mr, .,L��=G �,L Z�qODRESS s��� ���� �.U,� �,(F ZIp CONTR.UCENSE N <br /> � Cu��'7 Qa <br /> PHONE L12�_1j7}./' �?�O LIAK-E'S�c.�JQII$� U.�' IB�SS <br /> r Drm�-c.r�0003� <br /> � P/�ROPOSED USE OF BUILDING I Building Mechnnical Addition HEAT SOURCE <br /> I I ,��uI,, - � PERMIT B Com6ination �Plumbing IWORK � AlteraUon i�,Electric <br /> L +�-� TYPE D Demolilion Sign TYPE New I ❑ Ges <br /> ��� U Sprinkler Repair/AAaint. D Olher <br /> CONTHACT PRICE OF WORK ��f t I O� OU CITV OF�VERETT LOCAL SALES TA%CODE IS 3105 <br /> i I l <br /> i WOHK DESCR!PTION <br /> �i� �.K; S+�,�S �-�� uy,��- ���c ,�So�a-�� <br /> iDuc�-���� <br /> � PLUMBING MECHANICAL f <br /> INO. TYPE OF FI%TUHE OR REM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATERCLOSET � A/C-A/HANDUNGUNITS A <br /> i _ BATHTUB _ FORCED AIR SYSTEMS �°� <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP �J <br /> _ SHOWER _ UNITHEATERS � � � <br /> KITCHEN SINK 8 D!SPOSAL _ CLOTHES DRYER 1^ / `� <br /> I _ DISHWASHER _ RANGE HOOD �� � `\ I <br /> I = LAUNDFYTRAY _ WATER HEATER i <br /> CLOTHES WASHER _ METALFIREPLACE/STOVE <br /> I = URINAL = FIREPLACE INSERT <br /> DRINK�NG FOUNTAIN GAS FIREPLACE <br /> i ! F�OOR DRAIN _ GAS FANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) EXHAUST AN <br /> j _ OTHER l OTHER_�i�� <br /> I HEREBY CEAITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL <br /> PR ISIO':S OF LAWS AND ORIDINACES GOVERNING 7NI5 TYPE OF WORK WILL BE COMPIIED WITH WHETHER SPECIFIED HEREIN OR <br /> N . H�.i�'ANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> S ATE H LU�AL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTNORIZED BY TNE <br /> NE OF TMIS PROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> NT CTORS LAW 18.27 CW AND 296.200 WAC. <br /> J \ �� <br /> � <br /> Signa e ol OwnerlConi to/Aut onze Agent are `/� I <br />