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P�RMIT APRLICATIc" N �=z� <br /> CITY OF EVERETi' PERMIT SERVICES <br /> 3200 CEDAR STFiEE7, tiVERETT, WA 98201 , <br /> 425-257-8810- FAX 425-257-8857 <br /> �T6 a�oZ r�� � (�SE fiU�d �rc� G�95/�7-LGtx�-Dis- Op P �MiT,r <br /> I �L�?lZ -6l Z- <br /> LEGAL LOT NO. BLOCK T CTA n <br /> DESC. /� • _�Ll.,�� ,(/�,.,�/ <br /> G((ti /c.i� /� <br /> OWNER ADDRESS ZIP PH NE <br /> /B/E� SO LL�.��'.�/1.(� <br /> ��z���s ,c%vi. �,✓� i(�t�.:.rxi1 l`�',�sF� ��jZ`5�.3�/-Q.S-,Z3 <br /> TENA NAME �pCTNAM PHONE <br /> I �e��i�;���!� (y7s)3��'/Os"7�' <br /> CONTRACTOR ADDRE5S LP CONTR.LICENSEI <br /> (�'�%c�.y! f�sc1S /1�GC� ?i�/G <br /> PHONE � ' <br /> �y?s)3�y o.s7_� ~ S���c L�,g�h�.uoyyk`k <br /> I PROPOSED USE OF BUILDING Building Mectianicai Addition HEl.T SOURCE <br /> PERMIT Combinalion 1R..( Plumbing WORK RI-.L Alieralion R Electric <br /> S�� TYPE Demolilion U Sign TYpE ,�Q New �j Ges <br /> Sprinkler u Repair/Maint. U Olher <br /> ICONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WOFK DESCRIP ON Q � <br /> �,w,6/�� .�ir,� -FP.�o(p�t�%�'- <br /> �f� � �� I <br /> PLUMBING MECHANICAL <br /> INO. TYPE OF FI%TURE OR REM NO. TYpI OF FIXTURE OR ITEM <br /> IWATER CLOSET — A/C—A/HANDLING UNITS <br /> BATHTUB _L FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> ,� SHOWER UNIT HEATERS <br /> L KITCHEN SINK 8 DISPOSAL f . C.t 7THES ORYER <br /> � DISHWASHER I Rn�VGE HOOD <br /> — LAUN�RY TRAY � WATER HEATER <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> I ^ URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN _L GAS FIREPLACE <br /> � FLOOR DRAIN I GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> � = SINK (S[P.VICE/8,4R/MOP/ETC.) _ EXHAUST FAN <br /> = GTHER _ GTHER <br /> I HEREBY CERITIFY'HAT I HAVE RE'�".�.;!n F`,AMINED THIS APPL�CATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINA;c'S GOVERN�NG THIS TYPE OF WORK WILL BE COMPLIED 4VITH WHEfHER SPECIFIED HEREIN OR <br /> ! NOT. THE GRANTING OF A PERMIT;)OE:�.NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I 4M AUTHORIZED BY THE <br /> OWNr.R OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAUE AND I COMPLY WITH THE STATE <br /> CONy�iA ORS LAW 1 27 RCW AND 296200 WAC. <br /> ��/��..Y�l /7/� o� <br /> Signa�ure of O�+ne�/Cor,tractodAuthonzed Agent Date � <br /> d <br />