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r <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRE33 PARCEL TAX I.D.N PEHMIT N <br /> �yG C:Agi,vo � � � � ZS� y/3oo � os3oo � p _ ob <br /> LEOAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE88 PHONE <br /> Glii le�rl.✓�s v, ll A�n f?o. ' uK 99 z ��.,on.�.c�Q �,i4 L/zS- 77s= Lo)o <br /> TENANT NAME CONTACT NAME PHONE <br /> �ti;i�/.�ws v, �i.�aL sfc�c Pco��J, y�s�- ��G-��rsr <br /> CONTpACTOR ' ADDRE68 CONTR.LICENSEN <br /> /3e i.r N e u✓ c o /?o. d�x s z 6 q �r.�„v c o 77 e i+, <br /> PHON@ L�rNNwo�l� � w� S�oYL <br /> y:s- ��6- 8&3�� <br /> PROP09ED USE OF BUILDINO Bulldinp Mechanical Additbn HEAT 80URCE <br /> PERMIT B Combinelion�lumbinp WORK Anareiwn D Eiectr�c <br /> TYPE D Demolillon Ign TYPE aw D Oes <br /> U Sprinkler RepelrlMelnl. U Other <br /> CONTRACT PRICE OF WORK � 7 �p a� CITY OF EVERETT LOCIIL SALEB TAX CODE IS 0106 <br /> WORK DE8CRIPTION j,vs�q [c C/) 5 i3,✓ c q1,ar f o,i t rc.s/.� S'�rc a...t L <br /> �t� is�ry 3�' ���trl <br /> �L1�M�1t�o ME�li�lLC�L <br /> NO. tYPE OF FIXTURE OR REM N0. TYPE OF FlIITURE OR fTEM <br /> WATER CLOSET A/C—NHANDLIN4 UNITS <br /> BATHTUB FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP <br /> SHOWER UNIT HEATERS <br /> KITCHEN SINK 6 DISPOSAL CLOTHES DRYER <br /> DISHWASHER RANOE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKINa FOUNTAIN OAS FIREPLACE <br /> FLOOR DRAIN OAS RANOE <br /> 9ACKFLOW PREVENTER OAS PIPINO <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER OTHER_ <br /> 1 HEREBV CERITIFY THAT I HAVE RFAD AND EXAMINED TNIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL <br /> PPOVISIONS OF LAWS AND ORIDINACES OOVERNINO THIS TVPE OF WORK WILL 6c COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE�RAN71Na OF A PERMIT DOES NOT PRESUME TO OIVE AUTHORI?Y TO VIOLATE OR CANCEL THE PROVISION OF ANV OTHER <br /> STATE OP LOCAL LAW RE6ULATINO CONSTRUCTION OR THE PEfiFORMANCE OF CONSTRIICTION. THAT 1 AM AUTHORIZED BV THE <br /> OWNER OF THIS P PERTV f0 PERFORM THE WORK FOFl WHICH APPLICATION IS MADE AND I COMPLV WITH THE STATE <br /> CONTRACTOR 18 �WAC. <br /> / 'S 'U <br /> eture o wner/ onlractor ut�orize gent ele <br /> �0`�• 3 � <br />