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i __ <br /> � <br /> PERMI� APPLICATION <br /> CITY OF EVERETT PERMlT SEiiVICES <br /> 3200 CEDAR STREET, EVERETT, WA 56201 <br /> 425-257-8610— FAX 425-257-8857 <br /> 'i SITE ADDA J„ V \v,� l • VV � �\�\� C O )O�`1�1jly ) I PE 71T a ' <br /> `-\ ,� 's�3n� -o2z <br /> ' LEGF LOT N BLOCK TR/ACT <br /> I DESC. , � � L ��.7/1-N �� �S r/��.� <br /> I OWNER ADDRESS ZJP PH/GNE <br /> ''.. � u�f� L�4Z�, I/JL. I "1 ( � Si�Vi'(Z S(�2in/US l/`�Ry� SrA��OUD , \N /1 . G(/^ ! Z <br /> i <br /> TENANT NAME � CONTACT NAME /�Z�\ C PHONE ��` <br /> � � J r <br /> �J �/.� O a�-c �t�1�C � . 5 � �-,�x �� <br /> �(L � " y- 9 5, 334 - ., ,�`. 33c•=-�:.(, <br /> CUNTRACTOR ADDRESS ZiP CONTR.LICENSEN <br /> � PHONE �A/'M� � J4�G � �D���/���7 : <br /> � LXP. /O�LZI � 1 <br /> PROPOSED USE OF BUILDING � Building � Mechanical Addition • HEAT SOURCE <br /> S e �p � o PERMR Combinalion Plumbing WORK Alteration R Elecfric 1 <br /> TYPE Demolition Sign TYPE �New �¢ Gas , <br /> .. Sprinkler(a of heads) ( Repair/Maint. U Other , <br /> CONTRACT PRICE OF WORK CITY OF EVEREfT LOCAL SALES TAX CODE IS 3705 i <br /> WORK DESCpIPTION � <br /> ��Pr� �2,Zr3 � <br /> C�l�� �_\ 9 4� <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR REM N0. TYPE Or FIXTURE OR REM <br /> i WATER CLOSET(TOILE7) _ A/C—P✓HA�'DLING UNITS I <br /> � BATHTUB _ FORCED AIF SYSTEMS <br /> � � LAVATORY(WASH BASIN) _ HEAT PUMP <br /> I SHOWER UNIT HEATERS � <br /> � KITCHEN SINK 8 DISPOSAL � CLOTHES DP,1'ER � <br /> ' _� DISHWASHER �_ RANGE HOOD <br /> LAUNDRY TRAY �_ WATER HEAT�a <br /> � CLOTHES WASHER METAL FIREPLACE/STOVE <br /> _ URINA! FIREPLACE INSERT i <br /> _ DRINKING FOUNTAIN GAS FIREPLACE � <br /> FLOOR DRAIN 1 GAS RANGE <br /> BACKFLOW PREVENTER 1 GNS PIPING � <br /> SINK(SERVICE/BAR/MOPlETC.) � EXHAUST FAN <br /> _ OTHER _ OTHER `�O\� <br /> - � - Q�� ; <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINEO THIS APPL�CATION AND KNOW THE SAME TO BE TRUE AIJD CORRECT. ALl <br /> PROVISIOIGS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE CO�dPLIED WITH IWHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUAIE TO GIVE AUTHORITV TO VIOLATE OA CANCEL THE PROVISION OF ANY OTHER I <br /> STATE OR LOCAL LAW REGULAT�NG CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TH4T I AM AUTHOR!Ze'D Bl'THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I CO�dP�Y WITH THE SThTE <br /> CONTR RS LA\N 18.27 RCW AND 296.200 WAC. <br /> /-�Ct ,if '� �/�!./U 3 <br /> Signature of OwnedContractodAuthorized Agem � Date �L <br />