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� PE.. �MIT APPLICATIO�: <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS pARCEL TAX I.D. # PERMIT a <br /> 10701 EVERGRG�N WH'�( s - �3 <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS LP PNONE <br /> /1R�1 �Ol.LISIUN ►U'1UI ��RUREer� kl�iY 31o0.y�'r.3� <br /> TENANT NAME CONTACT NAME .���f / /7(%, � � PHONE <br /> II <br /> K.�T�t�YN Coi38 � .��.� � � 360.459.3aa� <br /> CONTRACTOR ="�j SI�JNS�W C. ADDRESS gZ 6� ��y�� pL����ip CONTR.UCENSE M <br /> LAiEY, �l/r 98.`5((v SFIVEs��s1U3 <br /> PHONE ,�0,��•3r�O <br /> PROPOSED USE OF BUILOING Building rl MechaniCal Addilion HEAT SOURCE <br /> � PERMIT Combinalion �� Plumbing WORK Alleretion Electric <br /> CoLusluN c.EN"�— R <br /> TYPE Demolition Nj Sign TYPE New �J Gas <br /> Sprinkler Repair/Maint U Other <br /> CONTRACT PRICE OF WORK �,r'j I� I CITV OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK DESCRIPTION <br /> TNSl'.ML ON�CI) ��yuM1NArE FL�K F✓K� SFRuc-T�.(l2E 3�/2�TX 35'L <br /> z'NT�u-oN�U) nIAV-l�CuwttN,t7�A SIUN P�1Et, <br /> PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> I _ WATER CLOSET _ A1C—A/HANDLING UNITS <br /> � _ BATHTUB FORCED AIR SYSTEMS <br /> � _ LAVATORY (WASH BASIN) _ HEAT PUMP <br /> _ SHOWER UNIT HEATERS <br /> I _ KITCHEN SINK 8 DISPOSAL _ CLOTIIES DRYER <br /> _ D!SHWASHER _ FIANGE HOOD <br /> j _ LAUNDRY TRAY WATER HEATER <br /> ! CLOTHES WASHER METALFIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSEFT <br /> � _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> � FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFY 7HAT I HAVE READ AN� �XAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFiECT. ALL <br /> PAOVISIONS OF LAWS AND ORIDINACES GOVEPNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OF CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAI LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY'O pERFORM THE'NORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRACTORS LAW 1827 RCW AND 296.200 WAC. <br /> � /�� c�-�i—o4 � <br /> Sig�n lure of ner/ onlractor/Authorized Agent Date �ra <br />