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�cRMIT APPLICATC>N <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> C 425-257-8810- FAX 425-257-8857 /� <br /> 1 8�� � fSoa�o o4a� <br /> SITE ADORESS PARCEL TAX I.D.M PERMIT w <br /> 4�� � . �ov - o00 00 �a�t-� <br /> LEGA �OT . BLOCK TRACT <br /> DESC. <br /> OWNER ADDRES$ � ZIP PNONE <br /> 1� �,ro.-� � 1 9 qo�� 144i�W�, N� �..�,. � ` �� 9 S��'1 a <br /> TENANTNAME I COHTACTNAME PHONE <br /> �1� I.ShS�f�9 , w�- Y/ .� 3-9e� ��9Q <br /> CONTRACTOR P��p��� P����� .r.ppDRES3 LP CONTR.�ICENSE Y <br /> .���k <br /> PMONE pA�2r FPoS�lcr— <br /> a�-3-q � - a�o� �o� F_ w <br /> PROPOSED USE OF BUILqNG Building Mechanical AdCition HEA7 SOURCE <br /> PERMIT � C�mbination � Plumbing WORK � qteratfon (7 Electric <br /> TYPE Dertwlition Sign � TYPE New R Gea <br /> S rinkler epair/Maint LJ Other <br /> COHTMCT PRICE OF WORK � �oo pp CRY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> WOqK DESCRIPTION <br /> ` ��FZ� �++�- �1n�n�.,r�r.�w�S '�`or�ew oH.�tiC.vraA . �a� �,. a�1 <br /> o� a <br /> PLUMBING MECHa4NICAL <br /> NO. TYPE OF Fl7fTURE OR ITEM NO. TYPE OF flXTURE OR REM <br /> f _ WATERC�OSET _ A/C–A/HANDLINGUNITS <br /> E _ BATHTUB _ FORCED AIR SYSTEMS <br /> I _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> I _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WqTER HEATER <br /> _ CLOTHES WASHEFi _ METAL FIREPLACE/STOVE <br /> _ URINAI _ FIFEPLACE INSEAT <br /> � _ DRINKING FOUNTAIN , _ GAS FIqEPLACE <br /> , _ FLOOR DRAIN _ GAS RANGE <br /> � _ BACKFLOW PREVENTER _ CaAS PIPING <br /> _ SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHEF _ OTHER <br /> — � ��, c^.,1,La.r <br /> i <br /> I HEREBY CERITIFY 7HAT I HAVE fiEAD AND EXAMINED THIS APP�ICATIUN AND KNOW THE SAME TO BE TRUE ANO COfiRECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITM WHETHER SPECIFIED HEREIN OR <br /> NOT. 7HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISIOfd OF ANY OTHER <br /> STATE OR LOCAL L4W qEGUL4TING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. TMAT I AM AUTHORIZED BV TNE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MADE ANO I COMPLY WITH THE STATE <br /> l VTRACTOFS L4W 7827 qCW AMD 296200 WAC. <br /> 1/ .�G-(o7.. !1 iC�"�.L�--� /l/i r� '+ <br /> Signature of Owner�ontractod utbonzed gent te �� <br />