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PERMIT APPLICATIO� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> %' : i '. /�i <br /> SITE ADDRESS �G�P CAR EL TAX I.D N PE T M � <br /> �Tff � 6sa�ax�6 '��r'_ <br /> LEGAL LOTNO. BLOCK TMCT <br /> DESC. <br /> OWNER ADDRE8S ZIP PHONE <br /> h1SR a anPME{J Fsf2S � (�TH �I25-8u-4y66 <br /> _D�.� S 1 � AVE �.1� 5�.t'F ic» F~�RkL�D�WA 46033 <br /> TENANTNAV.� CONTACTFOq PERMIT PHONE <br /> MSR ��EvEcAAh�t� <br /> �/�� Lvsk�j��.l1iC_AL iZ'/Ptt�1 L.YN N <br /> CONTRACTOR �� �ADj�ES32� �yNNUXu�7 wA qz�q�b ����M��1�G7c.1 <br /> OLYMP'� Mf�-HAN`.�(:�- �LI�C� � <br />� PHONE <br /> 'i�- 77N -8ay <br /> PROPOSEDUSEOFBUILDIN6 B�Ilding gjMechanicel Atldilion HEATSOURCE <br /> PERMIT B CombinaUon Y� Plumbing WORK�Nteretbn �Eledric <br /> TYPE [] Demoli6on �J 3ign TYPE New Oaa <br /> U Sprinkler RepairlMaint. Ot�er <br /> CONTRACT PRICE OF WORK �� rn-,.�1 CITY Of EVERETT LOCAL SALES TA7(COOE IS 3105 <br /> v.10./ <br /> WORK DESCRIPTION ,�,Ns7'(�{,(,q���.l OF -To �7LpF'�Oj� F�NTF�. �S <br /> htFl�TS(���[.EL'f2� Ccnt,tNG- �nNLT3 �TH s�PP�y [�rNa R,�'Tu2t�4�2 t�T- <br /> I�PS Fv� Fu7tti�rL hslZ 6aMF�D;sTR�6tnT.[oN . C>AS PTP=h�- Ft�oM �t�CVstxnAt <br /> N1���S 'CU 6 Rtx�'far �WS¢. <br /> PLUMBING MECHANICAL <br /> NO. � TYPE OF FI%TURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> WATER CLOSET A/C—AhiANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORI�(WASH BASIN) HEAT PUMP <br /> SHOWER UNIT HEA7-ERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACElSTOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR ORAIN GAS RANGE <br /> DACKFLOW PREVENTER —G GAS PIPING <br /> SINK(SERVICEIBAR/MOPIETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFY THA i I HAVE READ AND EXAMINED THIS APPLICATION A�ID KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORI�INACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO OIVE AUTHORITY TO VIOLATE OR CANCEL'fHE 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 THIS PROPERTV TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT ORS LAW 10.27 RCW AN�296.200 WAC. <br /> �` - 2-/y os <br /> Iipn of OwnedCoNracrorlAuthorizad Agent ate <br /> � DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />