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;�a � <br /> �''ERMIT APPLICA�'10N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRECT, EVERETT, WA 98201 , <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.A P� MfT N <br /> 9�/.3 26'`�'�� .s�' G�9yo7--ooe-a/�/- oo �2�Z-�ll <br /> LEGA LOT y . BLOCK TR /J�O� ��� <br /> DESC. / d/ <br /> OWNER ADDRESS ZIP PHONE <br /> l.�ts/ /�,�f .d. a/. �� /1�i6.�<,�.s,�tis,�,/ �zs� �vrs)��i-os�3 <br /> TENANT AME CONT NAME PHONE <br /> � � -��,�< <s��.� �y>33�/�s�3 <br /> CONTRAC70R '/ ADDRESS . LP CONTR.UCENSE• <br /> ��q�/ �^�/C> NG//. ��if/L' � � . . <br /> / <br /> PHON�zS-33/G5�3 � •� LE6f1cN�o � <br /> y%�K <br />� PROPOSEDUSEOFBUIL�ING Building fl Mechanical Addition HEA7SOURCE <br /> ��� PERMIT � Combination F� Plumbing WORK jR..j Allerellon R Electric <br /> TYPE Demaiition �� Sign TYPE ,�1 New u Gas <br /> Sprinkler U pepai4Maint. U O�her <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WOF.K DESCRIPTION <br /> i <br /> !/l/✓!C� _ ZZ Z� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM NO. TYPE OF FIXTURE OR REM <br /> WATER CLOSET ��( A/C—A/HANDLING UNII"S <br /> � BATHTUB I I/ � FOFCED AIF SYSTEMS <br /> LAVATORY(WASH BASIN) /// _ HEAT PUMP <br /> --' SHOWER UNIT HEATERS <br /> � KITCHEN SINK&�ISPOSAL t CLOTHES DRYER <br /> ! DISHWASHER � RANGE HOOD <br /> — LAUNDRY TRAY ( WATER HEATER <br /> J_ CLOTHES WAS:IER _ METAL FIREPLACE/STOVE <br /> = URINAL FIREPLACE INSERT <br /> '— DRINKING FOUNTAIN � GAS FIREPLACE <br /> = FLOOR DFAIN GAS RANGE <br /> = BACKFLOW PREVENTER �� GAS PIPItJG <br /> = SINK (SERVICE/BAR/MOP/ETC.) � EXHAUSTFAN //// <br /> _ OTHER _ OTHER <br /> i —I . <br /> I HEREBY CERITIFY 7HAT I HAVE REPO AND EXf,iv11NED THIS APPLICATION A�'D KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVEFNING THIS TYPE OF WORK N ILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> ! NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � STATE OFl LOCAL lAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER O TH�,S PRUPERN TO PEFFOFiM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTR S 1@27 RCW 296.200 V:4C. <br /> _ �,��c",�i��.�..� /z/Z-Cz <br /> Signatur ot OwnedConlractodAuthonzed Agent ate � , <br /> 'lz <br />