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� °ERMIT APPLICA��ION <br /> CITY OF EVERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> PU� ��� �� -D�� <br /> SITE ADDRESS .�/� PARCEL TA7C I.D.1 <br /> 9`f" G (o/n�K S. C, P�RMR M <br /> UU9 a7- �--Utz . oo LOZl2-G/G <br /> IEGA LOTNO. BLOCK TRAC7 <br /> DESC. �3 ,U /J Q�� <br /> �� <br /> OWNER ADDRESS �� <br /> lP�l<u SO, L{(��,_.�.,,/5 ZIP PMONE i <br /> /�� �.��� N w. �-,�� ��� �.. �f �9��s� (��Is�.�3y�i.� <br /> TENA NAME I CO ACT NAME ' <br /> ` -`/ PHONE � <br /> �� �z'� -�°� �yzs'.3.�`/d.S�3 4 <br /> CONTRACTOR ADOqESS , ZIp CONTR.LICENSE N <br /> LtN.1r�J�iu�s �c%r,v. �,vc ��,2,Q��'� ( 08�� <br /> �PHO r ��S ;�. <br /> �s�3'�'S/-c��-�.3 - ��y� �-, Lr�-���/o/�1�'K ', <br /> PROPOSED USE OF BUILDING Bwlding D Mechamcal �' <br /> PERMIT � Combination U Plumbin ' Addifion fIEATSOURCE <br /> � 9 WORK Alteration Electric � <br /> /� 7YPE Demoiilion U Sign IYpE New � Gas � <br /> J Sprinklef RepaidMainl. Olher ; <br /> CONTRACT PpICE OF WORK CITY OF EVEREIT LOCAL SALES TAX CODE IS 3705 � <br /> WORK DESCRIPttON // <br /> � �� f�f�L'�'ct:.-e� " <br /> 5/.�/�/f�7i:! y E <br /> ^ <br /> ���C 2�/[�j �� <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYpE OF FIXTURE OR REh1 NO. TYpE OF FU(TURE OR ITEM � <br /> WATERCLOSET — A/C–A/HANDI.INGUNITS <br /> � BATHTUB � FORCED AIR SYSTEMS <br /> LAVATORY (WASH BASIN) �, HEAT PUMP <br /> �"' SHOWER ^ UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL _L CLOTHES DRYER <br /> DISHWASHER <br /> LAUNDFiY TRAY RANGE HOOD <br /> � CLOTHES WASHER WATER HEATER <br /> = URINAL = METAL FIREPLACE/S70VE <br /> = DRINKING FOUNTAIN — FIREPLACE INSERT <br /> = FLOOR�RAIN GAS FIREPLACE <br /> = BACKFLOW PREVE�JTER GAS RANGE <br /> _s SINK(SERVICE/BAFUMOP/ETC.) GAS PIPING <br /> _ OTHER_ �� EXHAUST FAN <br /> _ OTHER <br /> �_ <br /> i — <br />� <br /> I HEREBY CERIT�FY THA`I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />� PRUVISIONS OF LAWS AND ORIDINACES GOVERN�NG THIS TYPE OF WOFK WILL BE COMPLIED WITH WHEfHER SPECIFIEO HEREIN OR <br />! NOT. THE GRANTING OF q PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE Ofl CANCEL THE PROVISION OF ANY OTHER <br />� STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 9Y THE <br /> OWNER OF THIS PRO(((PERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE S7ATE <br /> CONTqAC���7 G� D�WAC. <br /> /�`Z�v�O�. <br /> Signalur of OwnedContractodAuthonzed Agent Date ^ <br /> ( ��L <br />� � <br />