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� PERMIT APPLIC� iION <br />CI �'Y OF EVER�TT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-9810 - FAX 425-257-6857 <br />SITE 7ADDRESS <br />C� z `� �I � <br />LEGA LOT NO. <br />DES0. /D <br />OWNER <br />L?i��i/ /1c"rUi� S Ii�l �' .�y <br />TFNANTNAME <br />CONTRACTOR <br />PMONE <br />PROPOSED USE OF BUILDINO <br />_ Sf,i �w�,c �l7 <br />CONTRACT PqICE OF WOpI( <br />WORK DESCRIPTION <br />��� I <br />PLUMBIN <br />NO. I TYPE OF FIXTURE OR REM <br />BLOCK <br />� <br />� wq i tH GLUSET <br />� BATHTUB <br />i LAVATORY (WASH BASIN) <br />'= SHOW_R <br />L KITCHEN SINK 8 DISPOSAL <br />L DISHWASHER <br />LAUNDRYTRAY <br />T CLOTHES WASHER <br />� URiNAL <br />� DRINKING FOUNTAIN <br />_ FLOOR DRAIN <br />^ BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />� OTHER <br />PERMIT <br />TYPE <br />� <br />��� <br />ADDRES; <br />� �� �M. <br />CO AC1 <br />�1�� <br />ADORESS <br />� <br />� <br />� <br />PARCEL TAX I.D. / <br />7-OG27 C�/G- DQ <br />�rn�r <br />NAME <br />. �� 7'i' <br />PERMR I <br />CO3GS <br />yz; ��y os-�� <br />PHONE <br />_ yzs _ s�y_o�y 73 <br />LP CONTR. LICEN9E 1 <br />— ��n�s1.r� y�/P <br />8uilding MaCheNCal Addubn HEATSOURCE <br />Combinetion � Plumbing WORK � Alie�albn � Elecnk <br />Demolilion Sign T/PE New pe� <br />Sprinkler Repalr/MaiN. Other <br />CITY OF EVERETT LOCAI SALES TA% COUE IS 3108 <br />N0. � TYPE OF flJCTUAE OR ITEM <br />� <br />� <br />A/C — AlHANDLING UN TS <br />FORCED AIR S1'STEM;� <br />HEAT PUMP <br />UNIT HEATERS <br />CL07HES DRYER <br />FiANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE�STOVE <br />F�REPLACE INSERT <br />OAS FIREPLACE <br />OAS RANOE <br />GAS PIPIN6 <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERIiIFY THAT I HAVE FEAD AND EXAMINED THIS APPLICATION AND KNOW TNE SAME TO BE TRUE AND COARECT. ALL <br />PROVISIONS OF IAWS AND ORIDINACES GOVEHNINO THI6 TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED MER£IN OR <br />NOT. THE GRANTINO OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER <br />S7ATE OR LOCAL LAW REGUUTINO CONSTqUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY TME <br />OWNEH QF Tii15 PROPERTY TO.PERFORM THE WORK FOq WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRqCT6F5 LAyV 18. 7 RGN� AND 298200 Wqp, <br />� i <br />,, ��'—�ti� � , �. �/�,�('. _" 4 �� �L� <br />y�.) <br />