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� ERMIT APPLICAI�JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 <br /> SITE A`D�DAESS ( PARCEL TAX I.D.N PER1d17 M <br /> I�/7 �4 �' ,}�JL Jovil� �SI � � C�o11a.-0� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP� PHONE <br /> � o<<s+�c s�� l�� � ��� � s��+c� zn� S� `i�yol <br /> ^TENANT NAME ( COfITACT NAME PHONE <br /> I �l�(� �'✓ Ll)d'��l S KL���v� (�' �4n��e�S 3Gb � 739- �(333 <br /> I CONjRACT,qR C��S�v+[ J � OReSS ZIP CONTR.UCEYSE M <br /> J y K 1�g5 0�o 5�,��sH �,y/pyK2Z�j a Kron�-�v�l�l <br /> PHONE� 6 � - 73y- y333 ! ^ <br /> PROPOSED USE OF BUILUING Bui�uing �eCheniCei Addition MEAT SOURCE <br /> PERMIT e Cembination Plumbing WORK �Alterallon �Eiectric <br /> TYPE �'��Demolition Slgn TYPE New Gaa <br /> C� R-� U Spi;�kler Repair/Maint. Other <br /> COIlTRACT PHICE OF WORK 1 S QUU CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK OFSCRI�TION �tu/ `Ff IODU� �^S � tM u J L I.0 � I S �-4 ,�(J�G�✓ WCII II <br /> ����I��,i,l � .0 c.� s�n,1� � ,v�S�c�ll ��W-� C a�.,,,�-�+- <br /> PLUMBING MECHANICAL I <br /> N0. 7YPE AF FIXTURE OR ITEM N0. TYPE OF F�IRURE OR ITEM I <br /> � <br /> WATER CLOSET A/C—A/HANDLING UNITS <br /> I BATHTUB FORCED AIR SYSTEMS <br /> ' _ LAVATORY(�NASH BASIN) HEAT PUMP I <br /> ' _ SHOWER UNIT HEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER I <br /> _ DISHWASHER RANGE HOOD <br /> _ IAUNDRY TRAY WATER HEATER I <br /> CLOTHES WASHER METAL FIREPLACE/STOVE � <br /> URINAL _ FIREPLACE INSERT ! <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE I <br /> BACKFLOW PREVEtvTER GAS PIPING , <br /> T SINK (SERVICE/8AR/IdOP/ETCJ EXHAUST FAN <br /> _ OTHEfi _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE��AD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL 'i <br /> PROVISIONS OF�AWS AND OR�DINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR i <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORiTY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL L4W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE 'I <br /> OWNER OP THIS PROPERN TO PERFORM THE WORK FOR WHICH APPUCATION IS MA�E AND I COMPLY WITH THE STATE ' <br /> CONTFiAC FS LAW 18.27 RCW .ND 296200 WAC. I <br /> ��, ���� /� - /D - d Z <br /> Signalure ol OwnedContracrodAulhorized Agent Date T , <br /> � ��L <br /> r+•�� ' <br />