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i <br /> ��ERMIT APPLICA�'`ION ! <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> t <br /> SITE ADDRESS PARCEL TAX I.D.N pEq M � <br /> 9�z5 Z6r�� � oo9yo7-ooa-��b-�o o -G <br /> LEGA LOTNO BLOCK TRp�'T ij� �� � <br /> DESC. � p/y <br /> OWNEH F-C�l.� <br /> �H/�+SD �'il�G.f7reivr.i,�o� DP PHONE <br /> lt�rr�s/f/o,ws,�./�a, �',v� tK s�.,�s �z.s� ��1��3�x-os7�� <br /> TENAN NAME CONTACTNAME <br /> PHONE <br /> 1���� �,��s � ,���;�J �Sf��� %..,$).�3`/-�s�3 <br /> CONTRqC OR �` J �� ADDRESS TIP CONTR.UCENSE� <br /> L��.�y fx�.�r <br /> PHONE�CS —���/'��.�� � - �jJu� L�6�itNoyy,F'� <br /> PROPOSED USE OF BUII�DING 8uilding MechaniCel Addition HEAT SOURCE <br /> PERMIT �Combination R Plumbing IWORK�dlteration �Etectrk <br /> !�� TYPE Demolition � Sign IIYpE New Gas <br /> J Sprinkler RepaiqMainL Other <br /> CONTRACT PRICE OF WORK (:ITY OF EVEPE7T LOCAL SALES TA7C CODE IS 3105 <br /> WORK DESCRIPTIO <br /> �a��k ��'�� , . <br /> /�c�zz�� <br /> PLUMBING MECHANICAL <br /> NO• TYPE OF FIXTURE OR REM N0. TYPE OF FlXTURE OR REM <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> BATHTUB � FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) � HEAT PUMP <br /> �-� SFiOWER � ^ UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL � � CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> � LAUNDRY TRAY WATER HER''�i; <br /> Z CL07HES WASHER = METAL FIREPLACE/S"1'OVE <br /> = URINAL — FIREPLACE INSERT <br /> = DRINKING FOUNTAIN � GAS FIREPLACE j <br /> = FLOOR DRAIN GAS RANGE <br /> = BACKFLOW PREVENTER � GAS PIPING <br /> = SINK (SERVICE/BAR/MOP/ETC.) �I�� EXHAUST FAN <br /> = OTHER � <br /> _ OTHER <br /> i — <br /> i — . <br /> I HEREBY CERITIFY THAT I HAVE READ AND eXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL � <br /> PR0�11510N5 OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WIL�BE CO�dPLIEO WITH WHETHER SPECIFIED HEREIN OR <br /> ! NOT. 1�iE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br /> � STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF F IS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT RS 18.27 RC ND 296.200 WAC. � <br /> � l��_— /�_��� , <br /> Sign re ol Owner/ConlractodAuthonzed Agent Date � <br /> i/Z <br />