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� 1 <br /> i � — — <br /> PERMIT APPLICATIO�1 <br /> CITY OF EV�RETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857 <br /> B3�L �� ' <br /> SI DDRESS PARCEL TAX I.D.1! � P RMIT# <br /> ��oq ��e� ��P� �U�- 13�g 0 1 Da� Ooo - <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER / ADDRESS LP PHONE <br /> .Q I�I1��IIlU I G/T IC/I CPNLCI� ��/ P ,G( F�6� �� PH�� ���(-c�-oL // <br /> TENANTNAME CONTACTNAME <br /> Co�n���u,v,�, fl�.�ib� GJtit�,� Xe,vL�,eP�,� 4��a�-�y97 <br /> C NTRACTOR � ADDR5 LP CONTR LICENSEM <br /> )�j�'i�d i o ('D,Ua�UL'��aU =�' �9�`1'� Ce�//f,/�� ll�tl)Oz_ <br /> PHONE� �O.. 7�'�J�� ��/ ��1U�/!/L /��o,���lA 9��a �'��-C���r <br /> PROPOSEDUSEOFBUILDING B�ildlflg ) Mechenical Addition I HEATSOURCE <br /> PERMIT �II6TIItSinalion � Plumbing IWORK Altereti Electric <br /> I TYpE Demolition Sign TYPE New � Gas <br /> Sprinkle� RepairlMaint. Other <br /> CONTRACT PRICE OF WORK � � � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> / <br /> WORK DESCRIPTION <br /> TedIA,U�� Sinjl,ui' �e A�F�� . <br /> ,�¢ 4dJa-t_2� <br /> "-� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> WATERCLOSET _ AIC-AIHANDLINGUNITS <br /> BATHTUB _ FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER _ UNITHEATERS � <br /> KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER _ RANGE HOOD <br /> LAUNDRY TRAY _ WATER HEATER ��11` <br /> CLOTHES WASHER _ METAL FIREPLACEISTOVE \ �y' <br /> URINAL _ FIREPLACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE ` � <br /> FLOOR DRAIN GAS P NG plJ <br /> BACKFLOW PREVENTER — E7(HAUST FAN 1 <br /> SINK(SERVICE/BAR/MOP/ETC.) — OTHER <br /> OTHER — <br /> �H REBY CERITIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND COkRECT. ALL <br /> p VISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO W1TH WHETHER SPECIFIED HEREIN OR <br /> NO . INCa OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL W REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS ROPERN TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLV W1TH THE STATE <br /> CONTRACTOR W 8.27 RCW AND 298200 WAC. <br /> �`�.Z <br /> Signature of Owner/ContraclodAutho zed Agent ete <br /> �li <br /> �5. CQ���`.� ��� v �SQn �RES�DIC ConS,-) 36n•5o7• z575 � w�en �lrr,�,� iS <br /> rCg,1y <br />