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�_, <br /> P�. 1MIT APPLICATIO��: <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PER�dIT u <br /> o :�I �i9� S� D <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER pDORESS ZIP PHONE <br /> TENANTNAME CONTACTNAME PHONE <br /> h�R• ST• GicpuOR S�Qr� I v/c7'oR G,¢�l�iyRO �+ ,5?�q- 64') -S�y <br /> CONTRACTOR ADDRESS LP CONTR.UCENSEM <br /> EYfRGR�d S• � • A/c 2/�0 /�A�/F/c f1[.E 9��0� p2�16SSoaZoT <br /> PHONE <br /> �S.z- �//5' <br /> j PROPOSEDUSEOfBUILDING pERMIT hkyi Colmbination fR�y Plumbingal WORK RL�,' Aleralolion HEAnTSEQRCE <br /> G�a�O� S�Q� TYPE u DemoliliCn �J Sign TYPE �J Ne�v p� Gas <br /> u Sprinkler U Repair/Maint. �U Other <br /> CONTRACT PRICE OF WORK ��' C�$g CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> ✓ <br /> WOFK DESCRIPTION <br /> ' silis/. c c e2 ,�St%�g G� Rcb�Y7� </�/�TS ` Ql.�cT <br /> i <br /> , PLUMBING MECHANICAL <br /> - NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR REM <br /> _ WATERCLOSET _ A!C—A/HANDLINGUNITS <br /> _ BATHTUB � FORCED AIR SYSTEMS <br /> _ LAVATORY (WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE YOOD <br /> _ LAUNDRY TRAY WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINP.L _ FIREFiACE INSERT I <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOON DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER .T GAS PIPING <br /> _ SINK (SERVICFJBAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERI�IF'f'HAT I HAVE READ i,ND EXAMINEii THIS APP�ICdTION ANO KNOW THE SAME Tq BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS 1YPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GFANTING OF A PERb11T DOES N07 PRESUME TO GIVE AUTHORITY TO VIOLATE OFi CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGUWTING CONSTFUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8`(THE <br /> OWNER OF THIS PFOPERN TO PERFORM THE WORK POR WHICH APPUCATION IS MADE AMD I COMPLY WITH?HE STATE � <br /> CONTR W 18.27 RC'N AND 296200 WAC. <br /> .� /7�� 3- �s -05- <br /> Signawre of O�vneuContractor/Authonzed Ageni Date � <br /> 1 L <br />