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� �ERMIT APPLICA��ON '�� <br /> CI7Y OF EVERETT PERMIT SERVICES <br /> 320C CEDAR STREET, EVERETT, WA 98201 �I <br /> 425-257-A810- FAX 425-257-8857 <br /> : � 0� a�x�i- �3� ; <br /> SITE ADDRESS PRRCEL TAX I.D.8 P MI7 k <br /> '' .�,t 2-y�! �edla.+� D ��c� -O�v <br /> LEGA LOT O.� .�YWC. T/R�AC��7 <br /> DESC. �7 & r s� wY I�O/V � <br /> OWNER ADORESS 21P pHONE y�-3y <br /> G',9-ey �5 e ss� n l'!�, 80� ��. 4�9 ��r�,l 1,���- 9��� <br /> TENANT NAME CONTACT NAME PHONE <br /> �� I GA�v . I esso� v�r-s S��s-q8� <br /> CONTRACTOR A�D E S P CONTR.UCENSC N <br /> (��4-�y S�eS'�'Q� �O��pTC 2�4'`� C�U�z�U/�A� 9'�rlf�3 �l�SSO 1�/ D SS�`, <br /> PHONE <br /> PPOPOSED USE OF BUILDING BUilding f�Jviechanical fl Addition - 0 � <br /> � � ��e PERMIT Combination �i�Plumbing WORK F_� Alteration <br /> P � TYPE Demolition LJ Sign 7VPE �,j�New as ^ <br /> � Sprinkler L� Repaid�daint Other ' V <br /> � <br /> CON�RACT PRICE OF WORK �/ � �� CITY OF EVERETT LOCAL SALES TAX CODE I <br /> WORK DESCRIPTION <br /> i �U�� /S03 p,�t__S-���• <br /> / <br /> �ia2u 7SCo <br /> , PLUMBING , MECHANICAL <br /> � NO. TYPE OF PIXTURE OR ITEM � • �N0. TYPE OF FIXTURE OR ITEM <br /> i � . . <br /> I �_ WATER CLOSET /fi� / A/C–A/HANDLING UNITS <br /> �/� BATHTUB //i/ � FORC�D AIR$YSTEMS <br /> i LAVATORY (WASH BASIN) /y-f.� � HEAT PUMP <br /> I SHOWER •.� UNIT HEATERS � <br /> '� KITCHEN SINK& DISPOSAL � CLOTHES DRYER � /�� <br /> � � DISHWASHER � RANGE HOOD — �(9c �.n.- <br /> I LAUNDRY TRAY ,� WATER HEATER — <br /> � CIOTHES WASHER _ METAL FIREPLACE/STOVE <br /> I _ URINAL FIREPLACE INSERT <br /> , _ DRINKING FOUNTAIN ,� �E <br /> FLOOR DRAW � GAS RANGE <br /> I _ BACKFLOW PREVENTER <br /> _ SINK(SERVICE/BAR/MOP/ETC.) �� EXHAUST FAN � /*/�� /// <br /> OTHER_ OTHER <br /> I HEREBY CERITIFY'HAT I HAVE RGAD Af:O EXAMINED THIS APPLICATION ANO KNOW THE SAME TO 8E TRUE AND CORRECT. ALL <br /> PROVISIONS OF W WS ANO ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITr'TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR IOCAL LAW REGULATING CONSTRUCTION OR THE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> ' OWNER OF THIS PROPERTY TO PERFORM THE WOFK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> Signature of OwnerlContractodAulhorized Agent Date �/� <br /> - �'�� �a9S <br />