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( <br /> ' PEF�MIT APPLICATION <br /> I CITy OF EVERETT PERMIT SERVICES i� <br /> 32Cu CEDAR STREET, EVERETT, WA 98201 ' <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE AD RESS P RCEL TAX I.D.# P MIT a <br /> ����� _ ������ �� .�;� � C�'������ ���'���,���� ��� -o��� <br /> LEGAI LOT N0. BLOCK TRACT <br /> DESC. � � Lza� i3c�2�� Cs�rArs3 _ <br /> OWNER AOf;RESS ZIP PHONE <br /> Co �c� C2���, InJc.., � � � � 5��v:rc.SFrt,��Us �i'y, = -r,�� .��ro, �f✓�. 9$24� <br /> TEVANTNAME I CONTACTNAME ( c _� �-'f;, PHONt Gcc� <br /> r�!/n� � = ' _ <br /> UA�� �2rl� �., ' 3 • =� : 5, 33�1- 593U� 33�-}42� <br /> CONTRACTOR AODRESS ZIP CONTR.LICENSE N <br /> PHONE S�� . G oLoc,i � 0 3 UNG <br /> _ C-x P. /alLZf°3 <br /> PROPUSE�USE OF BUILDING R1 Building FRl Mecnanical Addition HEAT SOURCE <br /> PERMIT f4�-1('Com6inalion ��Plumbing WORK Alteration R Electric <br /> � TYPE �.j Demolitiun LJ Sign TYPE New Q�Gas <br /> � ` � � � U Sprinkler(H of heatls) Repair/Maint. U Other <br /> CONTRACT PRICE OF WORK I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WOR DESCRIPTION <br /> � �rr� lZ 3 ;, <br /> C> �ks� c� 2\ r1 \ . : <br /> PLUMBING ME�HANICAL <br /> N0. TYPE OF FU(TURE OF ITEM NO. TYPE OF FIXTURE OR ITEM <br /> L` WATER CLOSET(TOILET) A/C-A/HANDLING UNITS <br /> � BATHTUB J. � FORCED AIR S:'STEMS <br /> �_ LAVATORY(WASH BASIN) _ HeAT PU"dP <br /> SHOWER UNIT HEATcRS � <br /> 1 KIT�HEN S�NK 8 DISPOSAL � CLOTHES DRYEFl <br /> -T DISHWASHER � RANGE HOOD ' <br /> LAUNDRY TRAY i WATER HEATER � <br /> 1 CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN G�'•,S FIREPLACE <br /> F�OOR DRAfN GAS RANGE <br /> BACKFLOW PREVENTER � GAS pIPIMG <br /> SINK (SERVICE/BAR/MOP/ETC.) " EXHrUST rAN <br /> OTHER _ ` 0?HER <br /> I HEREBY GERITIFY THAT I HAVE READ AND EXAMINED THIS APPLIC%.TIOP�,:7:G F::C'.V-hE SAfAE TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LSWS AND OP.IDINACES GOVERN WG THIS T'/PE OF:'JOPK N�LL 3E �C�:iPL;c'D WITH WHETHER SPECIFIED HEREIN OR <br /> INOT. THE GRANTING OF A PERMIT OOES NOT PRESUh1E TO GI'✓E.-.UTi�OP��."� -�� :i�:_='E OR CANCEI THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULITING CONSTRUCTION OR THE?EP.F^P!.1.�':^.E:F '.C"STRUCTION. THAT 1 AM AUTHORIZED BY THE <br /> IOWNER OF THIS PROPERTY TO PERFORM THE WORK FOF'NHICH AP°L:-.:;-'I:"1 :5 LLJE.�ND I COMPLY WITH TH�STATE . <br /> CONTRI�C�OFS LAW 18.27 R�!{ND 296.200 WAC. <br /> lJ x..'. .{!�r���-D. ' - <br /> � SignaWre of OvmerlContractoVAuthorized Agent Deie �'Z <br />