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l ( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C�DAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.� PERMIT• <br /> z9so m��� �a� s�� 390(�S Ol/l� <br /> LEGA LOT NO. BIOCK TRACT F/iG('T il�m�� '� E��« <br /> oesc. jG7 5 _ <br /> OWNER ADDRESS ZIP PHONE <br /> /2�io/ E. Mw�l�n.�W►-IJk{S. CSQ,yi�A M.KX <br /> ��Ou/° �Ja/ � TX+Mr�GG �/Z�r� '7�Kaicw wA `��/L.s (f��) tBe�27 L <br /> TENANTNAME CONTACTNAME PHONE <br /> C�� ti�+�' I ��� �� �TN+� (yzf)&85 - 33 rs <br /> CONTRACTOR ��S/�E� ����• AD3 2 G O - �/B'I� IM� S,�'. av CONTR.LICENSE 1 <br /> PHONE 'K IV/�66 s7r/t� J� !1-L�v/��j �nl/.► r�a�r_ sn s <br /> Zs' 7'jb - �o°o <br /> PROPOSED USE OF BUILDIN6 uilding n MBChenIC81 I7 Addition HEAT SOURCE <br /> PERMIT Combinatlon K Plumbing WONK ���R!reratlon Electric <br /> ��q/�.-0�/G/� IB�L�, TYPE Demolition �� Sign TYPE �,.r NaW ceg <br /> Sprinkler U Repeir/Meinc Other <br /> CONTRACT PRICE OF WORK d 7!Q� �� CITY OF EVEqETT LOCAL SALES TA7(CODE IS 3105 <br /> WORKDESCRIPTION (��p,� . �Iti �(��` S�'�'K• W�—L � 3y/La'� NF,V <br /> N•�/- S�1s�•anr.C�r-- �7I�,.�! T� GA�r'E 4��Gyy� h�ui K 3'�7 . <br /> PLUMBING MECMANICAL <br /> NO. TYPE OF flXTURE OR REM NO. TYPE OF Fl7(TURE 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 HOOO <br /> LAUNDRY TRAY WATER HEATE9 <br /> CL'JTHES WASHER METAI FIREPLACE/STOVE <br /> URINAL _ FIREPIACE INSERT <br /> DRINKING FOUNTAIN _ GAS FIREPLACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW PFEVENTER _ GAS PIPING <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED TNIS APPIICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A VERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHURIZED 8V THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPIY WITH THE STATE <br /> CONTRACT S LAW 1827 RCW D 298200 WAC. <br /> � 3 <br /> Sig e o OwnerlContra oUAuth rize genl ate ��L <br />