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P�RMIT APPLICATIC y <br /> i CITY OF EVERETT PERMIT SERVICES ��`1g�� <br /> 3200 CEDAR STFEET, EVERETT, WA 98201 <br /> i 425-257-8810 — FAX 425-257-8857 � � <br /> C � 1/ - GD�-- <br /> SITE ADDFESS PARCEL TAX I.D.k PERMIT u <br /> ��c: � � os;�,ca t�T�� ti � ✓,� �,a �7 0�—04� <br /> LEGA LOT NO. BLOCK TRACT � ��� �. '(�� Q"'� iy -p Z, <br /> DESC. �{ 2� <br /> OWNER A�ORESS ZIP PMONE <br /> t P '.. ,� �7 �u I 1 c:v`�' oo S� �,yr-��ur� � �oV��✓--� �F d1�f(;" <br /> TENANT NAME CONTACT NAME PHONE <br /> 11 ,� <br /> �'�v�l� j"� ) 1J ��l�,r�,_) /-�� �� ' �-�,�, f�l3i �-��� L=`' 3) -Z�r- 3�1�' ! <br /> CONTRACTOR ADOFESS 21P CQNTR.LICENS[N <br /> �-t r._ � , ' <br /> � �� T �i �'! �'��ilL=� lc _) � 7 ��7 7� r F✓f, r . . "�'A�(z-l�P��� �- <br /> PHONE _�- �` <br /> ! ?_; 3 ) 7_8�r ".�4�2� ( ��sar�I-l� � W.p . '�✓�Z.� <br /> PROPOSED USE OF BUILDING � n Bwlding n MCChanlCal Addilion FiEAT SOURCE <br /> PERMIT ��� Cambination H Plumbmy IWORK � Alleraiion I � Electnc <br /> � U.�p �f:- ��`����� I TYPE �� Demolilion LJ Sign TYPE New Gas <br /> �!7 Spnnkler �epain�daim Otnar <br /> CONTRACT PRICE OF WORK ���� ���L� L O CITV CF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> WORK�ESCRIPTION �(i� �; 1J I' '��-� �✓i �/ o✓L�r Hl_� � �1 2�- <br /> �• � .��1:�7'ti�� <br /> � r' i � r� ftic�'� Il'� 1,,.1-i2P_" t'�- u� irJr 'J•=� • �.��. <br /> PLUMBING MECHANICAL <br /> NO. � TVPE OF FIXTURE OR ITEM NO. TVPE OF FIXTUfiE OR ITEM <br /> WATEA CLOS[T _ NC-A/HANULING UNITS <br /> �A7HTU� FORCED AIR SYSTEMS <br /> LAVATORY (WASH �ASIN) HEAT PUM11P <br /> SHOWER UNIT HEATEFS <br /> KITCHEN SINK 8 UISPOSAL CLOTHES DRYER <br /> DISHWASNER RANGE HOOD <br /> LNUNDRYTRAY WATER.4EATER <br /> CLOTHES WASHER METAL FIREPLACEiS70VE <br /> URINAL FlFEPLACE INS[RT <br /> _ DRINKING FOUNTAIN GAS FIFEPLACE � <br /> FLOOR DFAIN GAS RANGE � <br /> � BACKFLOW PREVFNT[R _ GAS PIPING I <br /> ._ SIMK (SERVICEiOAW�.IUP'ETC � EXHAUST FA�J I <br /> OT��ER_ ___ OTHER ___ <br /> I HERF�V CEFI7IFV THAT i HAVE READ AND EXAIdINED THIS APPLICATICN AND KNOW THE SAME 70 BE TRUE A��D CCRRECT. A�L I <br /> PROVISIONS OF LAWS AND ORIGINACES GOVERNING THIS NPE OF WORK WILL EE C01dPUED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT THE GPA�lTING OF A PEPI.IIT DOES NOT PRESUME TO GIVE AUTHORIN TO VIOLATE OR CANCEL THE PFOVISION OF ANY OTHER <br /> S7ATE OR LOCAL LAW REGULATING CONSTFUCTION OR THE PERFOfiA1ANCE OF CONSTFUCTION. 7HAT I AM AUTHORIZED BV THE <br /> O�VHER OF THIS PROPERTY TO PERFORM THE'NORK FUF WHICH APPLICATION IS IdADE AND I C061PLY WITH THE STAT� <br /> 'RACTORS LAW 1B 2,' RC'N ND 296 200�YA�. <br /> ) / / <br /> --�it / /'_��'� /�_ �1��`�� <br /> SignaWccrof Cw6�v � ntra tor,Authonzod Agenl Date � <br /> ��.�. . ;.i�' . /� . :. , � )l,ij• ) /� <br /> / � ; <br /> J. . . .. .. . .. . __ _._ . .. ._._ _ _ __-".--_" <br />