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� P�RMIT APPLICATIC)!V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CE�AR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS ..L PARCEL TAX I.D.# PE iT# <br /> go�[ - y g� St s,w ooyS670000oqoo z � - <br /> DESC. LOT NO. �.-� BLOCK TRAC��E�N�VEAI 1 ��T <br /> o�IJ-00 <br /> OWNER ADDRESS � 21P PHONE <br /> Eoic+Re6e�ca Sl,rorcr /],203 N�per Rl�e Rd 9�ao3 y�s�35S-961� <br /> TENANTI.AME CONTACTFORPERMIT AHONE <br /> I�.;� Sti.oy�r yas-yyH=aoss <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE# <br /> OWNE(Z �L-oic S�iroyer <br /> PHONE t�Zs_ /.� y_ OSS <br /> s s�s-�c ia <br /> PROPOSEDUSEOFBUILDING pERMIT � Sprnk'leation I ) Plumbingal WORK � �aPa�Maint. HEATSEectrio <br /> S/q�I� FqMII y Re 5 TYPE H Demolition D Sign TYPE New R O�er <br /> L� <br /> CONTRACT PRICE OF WORK ? /jC — C�TY OF EVERETT LOCAL SALES TAX COOE IS 31U5 <br /> ✓ G{./ <br /> WORK DESCRIPTION • <br /> r� ��tca�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO.. TYPE O�FIXTURE OR ITEM <br /> � WATERCLOSET(TOILET) /// A/C-A/HANDLINGUNITS <br /> `� BATHTUB ;� : FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) ///� HEAT PUMP <br /> 1 SHOWER I UNIT HEATERS <br /> �_ KITCHEN SINK 8 DISPOSAL �_ CLOTHES DRYER <br /> J_ DISHWASHER L_ R,4NGE HOOD <br /> �_ LAUNDRY TRAY _ WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> - URINAL � FIREPLACE INSERT <br /> DRINKING FOUNTAIN _L GAS FIREPLACE <br /> � FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> � SINK(SFRVICE/BAR/MOP/ETC.) EXHAUST FAN 7� <br /> OTHER OTHER <br /> — — lr.4s r�ei�.eR-7fhoiA�vr <br /> II HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TG BE TRUE AND CORRECT. ALL <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WIT�i V✓HETHER SPECIFIED HEREIN OR <br /> NOT. TFiE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PErZFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 27 CW ANO 296200 WAC. <br /> �v�D s19-r�- ��-a2-o3 <br /> Signature of Ow r/Contrac Authorized Agent Date <br /> DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br />