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� � � <br /> PERMIT APPLlCATlON <br /> � CITY OF EVERETT PEi2MIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810- FAX 425-257-8857 <br /> l�y' ��l ��7�h�CV�. S � <br /> SITE MDRESS PARCEL TAX I.�.# aE,3M17 u <br /> �� 9tl, s.��• A- tc3# 0057 Oot �1G � 1 ��l�l 4� - 3� <br /> LEGAL LOTNO. BLOCK TRACT <br /> �ESC. 5 <br /> OWNER ADURESS ZIP PHONE <br /> L?AQiN�� sc�uaR.c'_' U�vesr��c• PJ- r�k1o�9�Nor+omrsH.r�x, 9Pa9i ti�-5�33`�—�olb <br /> TENANT NAME CONTACT FOR PERMIT pHONE <br /> CONTRACTOR ADORESS 21P CONTR.LICENSE# <br /> CX-Y/h/�1G hlt�l�/1NtCALS�Vc ��p. 8ok 5�.:�� C.YNNu��O�GJh3c2xf6 ���ympmrl�oo� <br /> PHONE <br /> PROPOSEDUSEOFBUILDING pERM1T � Spnnkllef`ion � Plumbingal WORK �,j ReparlMai��, HEAfT�SEeRnE <br /> TYPE Demolition Sign TYPE R New B Gas <br /> ,�rrA,� u Other <br /> CONTRACT FRICE OF WORK C�CDU � CIiY OF EVERETT IOCAL SALES TAX CODE IS J105 <br /> WORKOESCRIPTION �"��Aj.(� /- �jJiv f/YAc. UNII j,�//TH 26uppa.G�ANd I� I2L�I�URNAt� I <br /> igRs�ip�'U) H�Ac. uni� /�w'OV/t7LrAN!'J 1/ENI l �3�T�4KVAM L�7GNAc(.S� FvQN � <br /> i PLUMBING i MECHANICAL � <br /> . �O. i TYPE�F FIXTURE OR ITEM i NO. I TYPE OF FIXTURE OR ITEM '� <br /> iNATER CLOSET I d/C-AMANDLING UNITS I <br /> —I BATHTUB � �I FCRCED AIR SYSTEMS , <br /> _I L4VATORY(WASH BASIN) =i HE4T PUPdP � <br /> �. �� 3HOWER � UNIT4�;ITERS � <br /> _I KITCHE� SINK 3 DISPOSAL ' � CLOi'HES DRYE:i <br /> i _; DISHWASHER ; RANGc HOOD <br /> ' LAUNCRY TRA'! � _i SVATER HEATcR <br /> ' —� CLOTHES'NASHER _; METAL FIRE°LACJSTOVE <br /> _; URINAL � � FIREPLACP iNSERT � <br /> . DRINKING�CUNTAIN i I GAS FIREPLACE <br /> � =Li;CR DRAW � I GAS RANGE <br /> : i oACi(FLOW PRE�/ENTER � / : GAS PIPING <br /> �� �' SINK(SERVICvBAR/bIOP/ETC.) � / EXHAUST FAN <br /> � _iOTHER I _ OTHER �. <br /> —j I <br /> i — <br /> —� � —i <br /> � I HEREBY CERITIFY THAT I HAVE RF�iD ANO EXAMINE�THIS APPLICATICN AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL �. <br /> � PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK'NILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR � <br /> , NOT. i HE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE?ROVISION OF ANY OTHER � <br /> � STATE OR LOCAL LAW REGUW7ING CONSTRUCTION OR THE PERFOR�dANCE OF CONSTRUCTION. THAT I AM AU7HORIZE�9Y THE ' <br /> O�VNER OF THIS PROPERTY TO PERFORM 7HE'NORK FOR WHICH APP!ICATION IS MADE AND I COMPLY WITH THE STATE � <br /> �. CONTRACTORS LAW 18�7 RC'.Y AND 296.200 WAC. � <br /> I ;�✓�.�.o-?..�.c.t�- _( �/`1/�� <br /> Si ture o wner/C ractor/Authonzeo Agent Date � <br /> i <br />, ! DEBIT S CREDIT CARDS ARE NOT ACCBPTED <br />