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t�ERMIT APPLICA�.ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> W�l <br /> SITE ADD_ RESS �`LL� PO U � µu p�` �3U 3 I.u J PERMfi M p�� <br /> ��� �1 6 <br /> LEOA LOT NO. BL1OfCKt�' TRACTr �,�_ ,,� <br /> DESC. 2 �- ��I �d -Yvu GV�w" ��� ��- ��!✓Z <br /> OWNER ADDRESS aP PMONE //�_7 �u_ <br /> Artt��. w. Skof�(,�,Q a�� � C�� by /�„„ S�G ��u o -�i�tw��F�� <br /> TENAM NAME (,�N n D COMACT NAME PNONE <br /> ���. � �-h� Sti-� �T,r)�o-3��� <br /> CONTRACTOR A/���� �rt�� �ADDRESS ��,f. [ Dlr.s (} nP COHrA.4CENSE• <br /> �� 1 d J ) <br /> PHONE ��b 763 U�6 I J�tw'� �`.�1 9d'OL MUN/�IeTC p�Qt/ <br /> / Q <br /> PROPOSED USE OF BUILpNG pERMIT Combi etbn P�mbin�l WORK ,�,ry�� �(T�qU� <br /> IW.(��'�`�� )�`^�` TYPE � �molf�on � Sign g TYPE � qepsiNMeint. LJ Olher <br /> U LJ <br /> CONTRACT PRICE OF WORK ,� �ij�� CfTY OF EVERETT LOCAL SALES TAX CODE IS J106 <br /> � <br /> WORKDESCRIPTION (U l�ts�� A �i♦"L�¢.� �U..1c�.f �'�OJC� $ys� � Q �t �x�s++� <br /> i <br /> �' (� Sw�,l��ffu( P��-. <br /> I PLUMBING MECHANICAL <br /> , NO. TYPE OF FlICTURE OH ITEM NO. TYPE OF RXTURE OR ITEM <br /> WATER CLOSET A/C-NHANDLING UMTS <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 HO00 <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN OAS FIfiEPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> SINK(SERVICFJBAR/MOP/ETC.) EXHAUST FAN <br /> OTHER _ OTHER <br /> I HEREBY CERITIFY'HAT I HAVE READ AND EXAMINED THIS APPLICATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PpOVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WOHK WILL BE COMPLIED WfTH WHEfF1ER SPECIF�ED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL T?1E PROVISION OF ANY OTHER <br /> STATE OR LOCAI lAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TMAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATON IS MADE AND I COMPLY WITM THE STATE <br /> CONTRACT9 fi/S LAW 1827 RCW AND 296200 WAC. <br /> l ` .i�� l 1u- ��� 'O�7i <br /> ignalure o wne ontractodAulhonzed Agent ata �/ <br /> y <br />