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PERMIT APPLICATI�N <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 CEDAR STRE'cl', EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT x <br /> v�,r h o0�1102. 000 00100 SG.�b/-0�� <br /> LEGA LOT O. BLOCK TRAC7 /� ' 1�, � <br /> DESC. l Z 3 �L'��Ta`r l.v h'�-- l�L N r er-,o�l-I- �C�t�S <br /> OWNER ADORESS ZIP PHONE <br /> ��� �,� �� z ��� /o��- st . # �i B.�vv-�� w�t qgoov Yzs- Y5�- 371.! <br /> TENANT NAME CONTACT NAME PHONE <br /> s g L`.� g1 ll 5-�-�e�,,.,o.r-4' 20 4� - y 4 Z - :�I b Y <br /> CONTRACTORDW1���Ls VlS1A.(nL AODRESS �14 �� A� S � LP CONTR.UCENSEN <br /> sysTf'.�*-S �,�,�. �wA rj'Y13 �/ DwIhEVSo7lo W�1 <br /> PHONE <br /> $'DO- �l'l� - 7YY (o � (07 '7- i - z.00•z <br /> PROPOSE6 USE OP BUILDING Building Mechanical Addition HEAT SOURCE <br /> c-1 �� � PERMIT R{-( Combinetion Plumbing WORK Alteraiion R Eiectric <br /> (�-N�-e-r"�-� .T� �-�. TYPE �j Demolition ign TYPE New �j Gas <br /> L� Sprinkler RepaidMaint. U Other <br /> CONTRACT PRICE OF WORK � CYC� t-� � p CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> O J <br /> WORK DESCRIPTION . � /� /i <br /> �in s-T-v��� o�.� .1 hT�eS� ov- 5 i oy,., Se�:N-(�'.r (3,e s r � +cc_ <br /> I '��ON k Z�� Z4 % 3�Z� $y(� ���1�l�(w!�^ 11•Al.�h'':� ��(S�- �ok / <br /> U F. f�1...*7 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> WATEA CLOSET A/C-PJHANDLWG UNITS <br /> _ BATHTUB � =` FORCED AIR SYSTEMS <br /> LAVATORY(WASH BASIN) _ HEAT PUMP _._�- <br /> SHOWER j _ UNIT HEATERS �•�� <br /> = KITCHEN SINK 8 DISp.O"SAL CLOTHES DRYEF �'" <br /> DISHWASHER / RANGE HUOD � <br /> _ LAUNDRY TRPyY� WATER HEATER <br /> CLOTHES WASHER METAL FIREPLAC TOVE <br /> _ URINAL� _ FIiiEPLACE IN RT <br /> DFIIN IfVG FOUNTAIN GAS FIREP CE <br /> FLO�R DRAIN GAS RA E <br /> _ BA�CKFLOW PREVENTER GAS P ING <br /> �INK (SEFV�CE/BAR/MOP/ETC.) I _ EX UST FAN <br /> � OTHER = ER <br /> I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF LAWS AN�ORIDINACES GOVERNING THIS TVPE OF WOFK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEFEIN OR <br /> NOT. TH�GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOfiITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STA''E Oa LOCAL LAW REGUTATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED 8Y THE <br /> OW�ER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONTRAC70R5 LAW 18.27 RCW AN�296.200 WAC. <br /> ` �i�� �- /J-O'1- <br /> Signature ol Uwn ontrector Autho ' Agent Dato ' <br /> � � <br />