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- P�RMI� APPLICATI(��V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETI', WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# � PERMIT a <br /> 57 �� - ID� h �D � Gl� DD-- FS�lc7-00o-DIZ.. 13QZ05-E13 <br /> LEGA LOT NO. BLOCK TRACT <br /> oesc. / a M�rr i 1) CYezK �7a rclehS �� V .2 <br /> OIYNEii ADDRESS <br /> 21P PHONE <br /> Je �'�' Koe �Imer S�-me. qg2o (yZs)3y4 -dcal <br /> TENANTNAME I CONTACTNAME PHONE <br /> J� F�' ��OC ��rVIeY `"�k (Zo'°) .z8o -`f SS 9 <br /> __ I{M �YZS) .3�1 '202/ <br /> CONTRACTOF AODRESS ZIP CONTR.LICENSE p <br /> QU���� <br /> PHONE <br /> � PROPOSED USE OF BUILDING kkk���yyyxxx� Building Mechanical Addilion HEAT SOURCE <br /> PERMIT � Combinalion � Plumbing WORY. � Alleration � Electric <br /> ^J ��h TYPE Demolition Sign TYPE New Gas <br /> Sprinkler Fepai/Mnint. Olher <br /> CONTRACT PRICE OF WORK //5 32� _ CITY OF EVERETT LOCAL S�ILES TAX CO�E IS 3705 <br /> G <br /> WORK DESCRIPTION <br /> Conver �t �.�� �� �all �vaw I s pAc�. � I'�v1 �� Rve�.. <br /> PLUMBING MECHANICAL <br /> i NO. TYPE OF FIXTUFE OR ITEPd NO. TYpE OF FIJ(T RE OR REM <br /> i <br /> WATER CLOSE _ A/C-A/HAN LING UNITS <br /> � _ BATHTUB _ FORCED AI SYSTEMS <br /> _ LAVATURY (W SH BASIN) _ HEAT PUM <br /> _ SHOWER _ UN(THEA RS <br /> _ KITCHEN SI 8 DISPOSAL _ CLOTHES DRYER <br /> , _ DISHWASH _ RANGE OD <br /> i _ LAUNDR'f AY _ WATER EATER <br /> _ CLOTHES ASHER _ METAL IREPLACE/STOVE <br /> _ URINAL _ FIREP CE INSERT <br /> � _ DRINKIN FOUNTAIN _ GAS F REPLACE <br /> � _ FLOOR RAIN _ GAS ANGE <br /> I _ BACKF OW PREVENTER _ GAS PIPING <br />, � _ SINK ( ERVICE/BAR/MOP/ETC.) _ EX AUST FAN <br /> _ OTHE _ OT ER <br /> � — <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PFOVISIONS OF LAWS AND OAIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> I i NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL THE 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 PFOPEqTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 18 27 RCW AND 2g6200 WAC. <br /> ��'�-�,�-�i-��� S��r'/�6Z <br /> Signature ol •y n qContractodAulhonzed Agenl Date <br /> � � � <br />� __�___ <br />