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PtRMiT /�PPLICATI�N <br /> CITY OF EVER(=TT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS �'�C� �''� PARCEL TAX I.D.# PERMIT# <br /> /��{ /3/�l/J�Ew�q ��2p� <br /> LEGA LOTNO. BLOCK TRACT � <br /> DESC. <br /> OWNER ADDRESS � ZIP PHONE <br /> ,p��r� w�T�i,� r .s��,� ��S- �s9r�zs <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ��h� ADDRESS Z�P CONTR.UCENSE N <br /> S,��T/� m�cTlu-✓ /eya7- si ��A�1:G. ` _ M � �s�s �I <br /> PHON L �VHIC� LwI �'�•2O� <br /> � I- .�- �7o76yc <br /> � <br /> PROPOSED USE OF BUILDING Bui�ding I� Mechanical Addillon I HEAT SOURCE <br /> PERMIT B Combinati0n �� Plumbing IWORK R PJleratlan D Electric <br /> r �� TYPE Demolition IJ Sign TYPE R Nav. Gas <br /> > � B Sprinkler �-1 RepairlMaint. Olher I <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 � <br /> WORK DESIRIPTION ' i <br /> �Tw-n-z� 1fie-nr�'-� Rr���« C��e,J � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO.. TYPE OF FIXTURE OR ITEM <br /> WATER CLOSET(TOILET) A/C—AIHANDLING UNITS <br /> BATHTUB FORCED AiR SYSTEMS <br /> LAVATORY(WASH BASIN) HEAT PUMP <br /> SHOW ER UNIT HEATERS <br /> KITCHEN SINK 8 DISPUSAL CLOTHES DRYER <br /> DISHWASHER RANGE HOOD <br /> LAUNDRY TRAY � WATER HEA'iER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE <br /> URINAL FIREPLACE INSERT <br /> DRINKING FOL'NTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> BACKFLOW PREVENTER GP.S PIPING <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 /> PftOVISIONS OF IAWS 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 GIVE AUTHORITY TO VIOIATE OR CANCEL THE PROVISION OF ANY OTHER I <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER OF THIS PROPERTY TO ERFORM THE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CONT �S LA 8.27 R AN/ . .200 WAC. �, � �� <br /> ignaWre o n d ctorlA onzed Agent Date <br /> DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED � 30 —U3�j i <br />