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�� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRE�T, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TOAJ(I.D,M PERMIT w <br /> �// 7 �3 r`� ve LJ Od G�Cn 95 OODOU DD p�Oa - D�3 <br /> LEGA L07 NO. BLOCK TRACT <br /> oEs�. 9 1 y � 3 <br /> OWNER AODRESS ZIP PHQNE <br /> IS�-lN� 1�'1 FS- �Q-rl'�'�"1l�ySP.� � 11 �a 3 r��✓e 4M.a� �'a03 <br /> TENANTNAME CONTACTNAME PHONE I <br /> -�Mobu �l7 �-SOI-�{4�I�� <br /> 3r��,/ �t,�e��� l�/�.Tc `lXs'�74�-S3W� <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE M <br /> (3r�or� L� )'VltNcs-✓r� Cous7'� 1'�VL 13 (0l9 Yvluk�l,tiosR.�wY )3R.=ANC►nDy4kr� <br /> PHONE y�s_ -743-S3y�J � 2z.s LYnnc,.,00�(W✓�- !`�yo3� <br /> PROPOSED USE OF BUILDING Building f"1 Mechanical Addiiion HEAT SOURCE <br /> PERMIT Combint�tion �� Plumbing WORK Alleration I7 Electric <br /> TYPE Demolition L7 Sign TYPE � New � � Gas <br /> Sprinkler Repair/Meinl. V Other <br /> CONTRACT PRICE OF WORK � u`OM� O O . CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> V \il.J <br /> WORKOESCRIPTION � ��"�� S.�,r4��c�L <br /> �i placc_ exrs�NVy coN�r-�:Fc. '('0.��v <br /> 5�0.�. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR REM N0. TYPE OF flXTURE OR ITEM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BA51N) HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> _ CLOTHES WASHER _, METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICE/BAR/MOPlETC.) _ EXHAUST F4N <br /> � OTHER _ OTHER <br /> I <br /> � I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br /> PROVISIONS OF W WS AND ORIDINACES GOVEPNING THIS TYPE OF WOFK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OF LOCAI LAW REGU V+TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPLRTY TO PERFORM THE WORK FOR WH APPLICATIUN IS MAOE AND I CO�dPLY WITH THE STATE <br /> CONTRACTORS LAW 18.2 CW AND 296.200 WAC. <br /> � Z-.S� <br /> Signature of Ow nt � Date 1/ <br /> I <br />