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� ERMIT APPLICAT�JN �"S�` xzxZy <br /> CITY OF EVEi�ETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425•257-8857 <br /> i�i� pU � � � a ���1 <br /> SITE ADDRESS PARCEL TN(I.D.A PEPMIT M <br /> I�XK I4 'n^ 5`�-, s� L t oF l9zSos-y-o�a-oc� C� a �-- � <br /> LEGA LOTNO. BLOCK THACT <br /> DESC. — S{►ptT-�SUBDIJIS��� ND� IZOZ"S-O � <br /> OWNER ADDHESS LP PMONE <br /> �{�Z} u�c�oo �, c 3bu -�Sz-193S � <br /> L.i�sry� F�a-i d C�.sr; ,�,,c. sn�.,,,,.�ovo, t�lik �8Z92 <br /> TENANTNAME CONTACTNAME PHONE <br /> ,�_ I .Tiw� wwna�s '-1zs- 9sy-�99,� <br /> T,�.a F�sat������ 4 z S- �-S4 -13�t3 <br /> CONTRACTOR ADDRESS LP CONTR.LICENSE• <br /> u F�sry� Mo.+��s ��o►�r, 'f�-Z� u�r�ao p 2A. V FE 5N CSd 4�/ KT <br /> PHONE 31.�0-�c�Z-19� S �Y�n1WQCsl1�H/Iq �BZ.�Z <br /> PROPOSED USE OF BUILDINO I � Bullding � Mechanicel Adduion HEAT SOURCE <br /> P'cRrn1T COmbin6ti0n Plumbing WORN Allereuai �n-f EleclrK <br /> S� TYPE Demolilion Sipn 7YPE New Ry �es <br /> 5pnnkle� Repeir/Ma�m. Li Othar <br /> CONTRACT PRICE Of WORIf ��S Oa� I 4iTr OF EVERETT LOCAL 9ALE8 TAX COtlE IB�IOS <br /> WORK DESCRIPTION <br /> N�1K C��sT7t�.l�'I7Q+.� S � <br /> iPLUMLlING MECHANICAL <br /> � N0. TVPE OF FIXTURE OR ITEM NO. T/PE OF fl)(TURE OR REM <br /> � <br /> � WATER CLOSET � NC -AlHANDUM�UNITS <br /> �ri 9ATHTl;� �_ FOFCED AIR SVS'EMS <br /> i � LAVATOFY (WASH BASIN; � HEAT PUMF <br /> SfiOWFR � UNITHEATEFS <br /> � KIiCHEN SINK 8 DISPOSAL � CLOTHES DRYER <br /> DISHWASHER 1_ RAN6E HOOD I <br /> I LAUNORY TRAY _L WATER HEATER <br /> CLOTHES WASI�ER � METAL FIREPLACE/STOVE <br /> � -- URINAL � FIREPLACE INSERT <br /> � DRINKING FOUNTAIN � OAS FIREPLACE <br /> � — FLOOR DRAIN _j_ GAS RANOE <br /> � — BACKFLOW PREVENTER � GAS PIPINO <br /> ^ SINK (SERVICE/BAR/MOP/E1C.) �: EXHAUST FAN <br /> — OTHER _ OTHEN _ <br /> !HEREBY CERITIFY'HAT I HAVE REAO ANO E%AMINED THIS APPIICATION AND NNOW THE SAME T06E TRUE AND CORRECT ALL <br /> PROVISIONS OF U1WS 4N0 ORIDINACES OJVEPNING TMIS TVPE OF WORK WIL�9E COMPLIED WITH WMETNER SPECiPIED MEREIN OR <br /> NOT THE GRANTING OF A PERMR DOES NOT PiiESUME TO GIVE AUTMORITV TO VIOUTE QR CANCEL THE PHOVISION OF ANV OTHER <br /> STATE OR LOCAL LAW REGULA`INU CONSTRUCTION OR TME PERFORMANCE OF C7NSTRUCTION. THAT I AM AUTMOF12ED BV TME <br /> I OWNER OF THIS PFiOPERIY TC FERFORId THE WOPN FOR WMICH APFUCAiION IS MADE AN01 COMPLV WITH THE STATE <br /> CONTRACTORS LAW 1B 2?ACJQ(AND 298200 WA� � <br /> � �+ /.Z-/4-,�.1Z <br /> Sig� , wneuContrac�ov uihonzed gen; �ete � <br /> f- � <br />� <br /> r <br />