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� � C`ERMIT APPLICAXaN <br /> j � CITY OF EVERETT PERMIT SERVICES <br /> �"' 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TA%I.D.M PERMrt M <br /> iv3i9 �-r,k-,��,�r ,���Av oo�o (3c��a-o�� <br /> LEGA LOT NO. BLOCK TRACT <br /> �ESC, i <br /> OWNER ADDRESS LP PHONE�� 4S�-S <br /> �t'�--'� �t"�ZTIES 1`j'►00 i44� Av� NE. Woor�.r�,��.t (.JA 9��2 <br /> TENANT NAME CONTACT NAME GMONE <br /> /�O uati5iti� L�JI?P, T�FF `l�ar.vn�iiL� f�2S- 7'7�/- 2'�US— <br /> CONTMCTOR t�(�iz�L I N� �TE.eSL ADDRESS LP�B.LICENSE M <br /> ��JLLV�rv'� C�. Z�6SL �D LX/� }��y �. � C[CQit3�_v/J� <br /> PHONE _/ L�' � ' �5�� S�P�Z�I C �C VZ /ti �` �T � <br /> PHOP0.SED USE OF BUILDING Building � Mechanical Addition I HEAT SOURCE <br /> �1' Lt�_�� '��u��C� PERMR B COrtlbi�etiOfl Plumbing WORK R /Uteratbn � Electrie <br /> ����� 7YPE D Demolilion Sign 7YPE D New Gas <br /> �,����. D Sprinkler U Repair/Maint. Ome� <br /> COMRACT PtUCE OF WORK /^�(� .vl CITY OF EVERETT LOCAL$A�ES TA%CODE IS 3105 <br /> V✓ �iV <br /> WOHK DESCRIPTION � / /_ /� <br /> ��� �/�q•-��'�7 G�� �a� C/J�C /�-�i!?s+� l�C�i[S`Do� �jiCG� <br /> 8'i lP f/"� 'I-rc��- 0 cU'n.21� <br /> �,eE�T /(v � ,��7L'k�iti(� ��lJ y�Li�7L �U.�� <br /> PLUMBING MECHANtCAL <br /> NO. TYPE OF FlXTURE OR REM NO. TVPE OF FlXTURE OR ITEM <br /> I� WATERCIOSET _ A/C-A/HANDLINGUNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> i = LAVATORV(WASH BASIN) = HEAT PUMP <br /> SHOWER _ UNIT HEATERS <br /> KITCHEN SINK 8 OISPOSAL CLOTHES DRYER <br /> DISHWASHEFi RANGE HOOD <br /> LAUNDRY TRAY WATER HEATER <br /> CIOTHES WASHER METAL FIREPLACE/STOVE <br /> I URINAL FIREPLACE INSERT <br /> DRINKING FOUNTAIN . GAS FIREPLACE <br /> FLOOR DRAIN . _ GAS RANGE <br /> BACKFLOW PfiEVENTER GAS PIPING <br /> _ SINK(SERVICE/BAWMOP/ETC.) EXHAUST FAN <br /> _ OTHER _ OTHER il <br /> I MEPEBY CERITIFY?HAT I HAVE READ AND EXAMINED THIS APPUCATION ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL I, <br /> PROVISIONS OF LAWS AND ORIDINACES GOVERNING THIS NPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR � <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PFESUME TO GIVE AUTHORITV TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER � <br /> STATE OR LOCAL LAW REGUL4TING CONSTRUCTION OR TY.E PERFORMANCE OF CONSTRUCTION. THAT 1 AM AUT1iOR12E0 8V THE . <br /> OWNEF OF Th ROPE TO FFOe7M THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITN THE STATE <br /> CONTRACT 5 W 27 RC D 296.200 WAC' <br /> � Z2 , <br /> �_ Signat of dConiractodAuthonzed Aga ate I L <br />