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P�RMIT APPLICATI���V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> rq� o ay���- <br /> SITE ADDRESS f'ARCEL TAX I.D.M PERMIT a <br /> ,�oo� 2� Rv� S.E . I ��a <br /> LEGA LOT NO. BLOCK TRAC7 <br /> DESC. <br /> OWNER ADORESS ZIP PHONE <br /> V�21�ti1 No2Tttw�ss I�oO �-I15� ST . �v+�2�T; 9s�3 425 2�t-S�lo$ <br /> TENANT NAME I CONTACT NAME m� � /�� pHONE �[ <br /> J� T�y'7� �� <br /> �l.t � � c � � ds <br /> CONTRqCTOR ADDRESS ZIP CONTR.LICENSE M <br /> 5T�d3 6 f IJS /�1�C.F1Ar�1 tcA2� ��C �{�{2Y� Z.��^ SC, S�� t�oTt-f�C.L 990�2 $TE8f3ML983 PA <br /> PHONE <br /> `�`L5 -N86 -oc,ao �(�Z5 - U��-f�22CceU � <br /> PROPOSED USE OF BUILDING Building Mechanical Adtlition HEAT SOURCE <br /> -����N�N� �QU(�IUEN( TYpEIT B Combination � Plumbing WORK � Altertion Electric <br /> BDemolition Sign 7YPE New � Gas <br /> Sprinkler Repair/Maint. U Other <br /> CONTRACT PHICE OF WORK �y �U�6y CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> JJ <br /> WORK DESCRIPTION <br /> �E�c./+�-az �f � r�� �u � Pn.��.-�� £ � �cc�,�1aY�-t� <br /> I PLUMBING MECHA�dlCAL <br /> I NO. TYPE OF FIXTURE OR ITEM NO TYpE OF FIXTURE OR ITEM <br /> _ WATER CLOSET � A/C—A/HANDLING UN�TS <br /> : _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) _ HEAT PUMP <br /> , _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CIOTHES DRYER <br /> i _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDflY TRAY _ WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> , _ URINAL _ FIREPWCE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/8AR/MOP/ETC.) �_ EXHAUST FAN <br /> _ OTHER <br /> _ OTHER <br /> I HEREBY CEfl171FY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SA�AE TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND OfiIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A pERM1T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULITING CONSTRUCTION OF THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OW ER OF THIS OPERTY TO PERFORM THE WORK FOR WHICH APPLICAT�ON IS MADE AND I COMPLY WITH THE STA7 E <br /> CO RACTORS� B.2 W AND 296.200 WAC. <br /> i - <br /> !0 -�-v'Z � <br /> Si ature of Ow er/ onlractoNAuthonzed Agent Date � <br /> t <br /> i <br />