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�cRMIT �4PPLICATi�JN � <br /> CITY OF EVFRETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425457-8810- FAX 425-257-8857 � <br /> SITE ADDRESS �9 PARCEL TAX I.D.M PERMI7 w � <br /> � 10 �� `' S� ��os i�a� �rm � Boao�-o:;� ' <br /> ' LEGA LOT NO. B�OCK 1'RACT I <br /> DESC. <br /> OWNER A.DDRESS ZIP PHONE <br /> �'oa s�� � ` �`r �6� �L� �j'ox S� 7 �'✓ 5�����-� '� <br /> TENANTNAME J CONTACTNAME PHONE <br /> I <br /> CONTRACTOR ���N /'•O r f-{- �rc ADLAESS LP CONTR. LICENSE N <br /> � � � /os// I S"� �� � r.,7�c C `r�r� <br /> PY.ONE �/�j 3� a/'� �vPr��� Gr9FfA1C1 l0`/K3 <br /> PROPOSED USE OF BUILDING Building fl Mechanical Addi�ion NEAT SOURCE <br /> o PERMIT Combination K Plumbing woRK Alleration Electric <br /> ��G�,eJ ' TYPE Demoiition U Sign IYPE New � Gas <br /> �� Sprinkler Repair/tdaint. Other <br /> CONTRACT PRICE OF WORK /�a� ?' CITY OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> WORK DESCRIPTION <br /> � ,v�,�s��«�� C I, <br /> r,�o P. �. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR REM NO. TYPE OF Fl7(TURE OR REM <br /> , _ WATER CLOSET _ A!C-A/HANDLING UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> � _ LAV,:TORY (WASH OASI�'J _ HEAT PUMP <br /> � _ SHOWER _ UNITHEATERS <br /> I _ KITCHEN SINK S DISPOSAL _ CIOTHES DRYER <br /> i DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> ' CLOTHES WASHER METALFIREPLACE/STOVE <br /> ,_ URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN GA5 RANGE <br /> BACKFLOW PREVENTER _ GAS PIPING <br /> SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER <br /> I HEREBY CERITIFI THAT I HAVE READ AND EXAMINED THIS APPLIGATION AND KNOW THE SAME TU BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF IAWS FND ORIDINACES GOVERNING TNIS T'PE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED Y:EREIN OR <br /> NOT. THE GPANTING OF A PERM�T DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL�W REGULATING CONSTRUCTION OR THE PERPORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> O ER OF THIS PROPERTY TO PERFORM THE WOFK FOR WHICH APPLIC�4TION IS h1ADE AND 1 COMPLY WITH THE STATE <br /> C N ACTORS L1W 1 27 C AN 2 .200 WAC. <br /> -- 7'I7-D <br /> 5 n ure of rl ,onlra r/ � e Agent Date �� <br />