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PL IMIT APPLICATICA \)J?moo <br /> CITY OF EVERETT PERMIT SERVIC - V <br /> 3200 CEDAR STREET, EVERETT, WA 98201 t <br /> 425.257-8810 - FAX 425.257.8857 <br /> SITE ADDRESS PARCEL TAX I.D.M PERMIT* 7� <br /> Ili\ 8oL sT SL.-) -Lizoo3oy oo So5 cxo—o3 <br /> LEGALL LOT NO. BLOCK TRACT /C (_'� 7 ,S <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> 5' lAO L-IhES:L—> A-4,0GOi—3 15b1 01 Tc& - c1q— g 81 b7 ICU- ss'S-21`t I <br /> TENANT NAMEI CONTACT NAME PHONE <br /> [ A( OJrA �,Z C.L44ic Cp'"u`✓ 'Ws-aitfi-ztic, <br /> CONTRACTOR ADDRESS ZIP CONTR.LICENSE 0 <br /> 1pperl cry FLo PRnTpi�eI�t. Z--To-1 1b! &c L" 984Zy <br /> PHONE TJ}(pMh LJA- Qp�TR.LYP0y4C..F- <br /> PROPOSED USE OF BUILDING jBijilding fl Mechanical Addition HEAT SOURCE <br /> PERh11T ombination IU( Plumbing WORK Alteration RR Electric <br /> TYPEemolilion Sign TYPE New Gas <br /> prinkler LLL��� RepairrMamL UU Other <br /> CONTRACT PRICE OF WORK dly� !!— CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORK DESCRIPTION ''YYr'' � <br /> "y) �3� ri1C� 5�2CNkLE �ti oF�t(E EF90�Tor1 - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET _ A/C —A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> CLOTHES WASHER. _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICFJBAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER _ <br /> I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE S AME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE CF WORT(WILL BE COI,APLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> O-ATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> ( IER OF THIS PROPERTY TO PERFORM THS WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> TRACTORS LAW 18.27 RCW AND 296.200 INAC. <br /> alure of OwnerlContractooAuthonzed Agent Date <br />