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' — <br /> PERMIT APPLICA,TIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, �VERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRFSS PARCEL TAX I.D.S PERMIT tl <br /> ��•z-i 1.� S�rtt�' 10 -C2�Z <br /> LEGAL LOT YO. BLOCK TRACT ^ I � � <br /> DESC. � `� (�+W9�! �wl�.���'1 � TC-�If.✓G� � <br /> OYJNER ' ADDRESS PHONE <br /> . � 22o I 36"°�"' Sf�w�� ; '�'� 259 tiS�� <br /> �nkrrna�l �uel Z,�c � <br /> TENANTNAME i �ONTACTPlAME i PHONE <br /> �/a � <br /> CONTRACTOR I AD�RESS � CONTR.LICENSEN <br /> $o{eUy Wol�srr� T��u,c�i.�J �� 2'LOfK W, Bo�,�� �o�� �G <br /> PHONE��J L �� � W80tl[�Kl✓/��L W 7 � 2b3 ��I�Q�' QQ•y <br /> PROPOSED USE OF BIiiLDING 8uilding [� Mechanical Addition E E <br /> PERMiT �Combination B Plumbing WORK R Alieration D Electric <br /> ��p TYPE Demolition Sign TYPE D Naw U Gas <br /> Sprinkler U Repair/MainL U Other <br /> CONTRACT PRICE OF WORK S 73� CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> WORK DESCRIPTION <br /> Re.r�to�e. h o u,ec A,N el a 6l o(.¢„bris.s o w�. S i�c. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET A/C-AJHANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOVVEH UNIT HEATERS <br /> KITCHEN S'NK& D�SPOSAL CLOTH[S DRYER <br /> DISHWASH=R RANGE HOOD <br /> LAUNDRY Tf1AY _ WATER HEATER <br /> CLOTHES SJASHEA METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKI!JG FOUNTAIN GAS FIHEPLACE <br /> _ FLOOR DRAIN _ GAS RANUE / v) <br /> BACKFLOW PREVENTER GAS PIPING o110 <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN 1 1 <br /> OTHEFl ` OTHER /\ <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COR(iECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK�VILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NO�T PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOC4L LAW fiEGUTATING CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br /> OWNER OF THIS PROPFRTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MA�E AND I COMPLY WITH THE STATE <br /> CONTRACTO S LAW 10.27 RCW AND 296.200 WAC. <br /> fD— Z—O� <br /> Si r ner/Con raclor/Aulhorized Agent Date <br /> _J <br />