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, __( - <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 ADDRESS P CEL T�x"I.D_.`• PE R M <br /> ��LtS.�X� OQ30lJ - <br /> LEOA LOT N0. BLOCK TRACT <br /> DESC. �� yj2 � <br /> OWNER ADDRESS �P PHONE <br /> ('1�od�Gl�c�'►�B�a�l �sTi� I?�2� ta..�bY�u� �a�` sf.�. wt.�a3 <br /> L-VLYl�i^�y•nr <br /> TENANTNAME CONT CTNAME PMONE <br /> �1���� I �1SrKDJt/SU.l.7J �AC.I fSG/°I(�lJ�l'I�S9�i 2G'!i.G5'Z.OI l t <br /> CONTRACTOR�I�,TL� •Ld�A�f+[.L'. ADDRE88 ZIP CONTR.LICENSE• <br /> �002 �on+ �l112ta� Q `c�(L'�LGA272 �f <br /> PHONE �.xo0 _'�(�• JJI 7S ��F'4M�ViN i V�I� pPJZC(b <br /> PROPOSED USE OF BUILDINO ullding fl Mechanical Additbn HEAT SOURCE <br /> �� PERMIT Combinalfon �_� Plumbing WORK �Iteralion � Electric <br /> riPE Demolilian LJ Sign 7YPE ew Oea <br /> Spdnkler RepalrMlaim. O�her <br /> CONTRACT PRICE OF WORK '�I2C,1�) CITY OF EVERETT LOCAI SALES TA%CODE IS J105 <br /> WORK DESCRIPTION r7� � � � � <br /> '(L.rNAr-*T I wt�lRwl�..ls►� �,L r.1L4.> �G �buti� �K�.ts Cb�ta�.. f�o-c.t b�t� <br /> IN '(Y�L• ��/M�-lUw� ftA.Wautw�Cdu.I�R�►+ Q� �LcxXL. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR REM NO. TYPE OF FlXTURE OR ITEM <br /> WATER CLOSET �_ A/C—A/HANDLINO UNITS <br /> BATHTUB FORCED A�R SYSTEMS <br /> � LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK&DISPOSAL _ CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRYTRAY WA7ER HEATER <br /> CLOTHES WASHER METAL FIFEPLACE/STOVE <br /> URINAL i FIREPLACE INSERT <br /> DRINKING FOUNTAIN OAS FIREPLACE <br /> FLOOR DRAIN GAS RANOE <br /> BACKFLOW PREVENTER GAS PIPINO <br /> SINK(SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> OTHER _ OTHER <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 AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO 61VE AUTHORITV TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL lAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CON ACTORS LAW 1827 RCW AND 296200 WAC. <br /> — Il�lg u( <br /> Si lure o OwnedConlraclor�lhotized genl e �/� <br />