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P�r�MIT APPLICATI�.J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADORESS PARCEL TAX I.D.• PERMI7 M <br /> '� ��w� f�V� oc 4 717 0 3 00 2U� �IZL <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS ZIP PMONE <br /> 7"�v� T-,✓L (�o BoX 389/059' TuKwrc.,a 98�3 g <br /> TENANTNAME CONTACTNAME PHONE <br /> '� - L 1/�iFxJ �7a�tl I �L55� �ox�(�ik.A�nl (ZG6) '¢Z 3- ,3b� <br /> CO RACTOR ADD SS ZIP CONTR.LICENSE N <br /> � -St�Fr ►titEGc-h�ivrcAc. j� �'O'`ss3r3i-3�o 48l g 3 �Rostwaxo�t..uC� <br /> PHONE <br /> ��� �(�/ -007 I <br /> PROPOSED USE OF BUILDING Building Mechnnical Addition HEAT SOURCE <br /> PERMIT Combination � Plumbing WORK � Alteration Electric <br /> R� �/� TYPE Demo�ition Sign TYPE New Gas <br /> r Sprinkler Repeir/Meint. O�her <br /> CONTRACT PRICE OF WORK /O � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> WORKDESCRIPTION � A_I �\�s�� <br /> /NSr/�LL 3 Sw KAvv !1N/'75 t�1� <br /> R�c�-z— 4N�S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM NO. TYPE OF flXTURE OR REM <br /> _ WATER CLOSET _ A/C—A/HANDLING UNITS <br /> _ BATHTUB _ FORCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDRY TRAY _ WATER HEATER <br /> _ CLOTHES WASHER _ METAL FIFEPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> _ FLOOR DRAIN A GAS RANGE <br /> I _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK(SERVICE/BAR/MOP/ETC.) EXHAUST FAN <br /> _ OTHER „� OTHER Coa117LJ5,v�1(�S/��7'� <br /> � I HEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> IPROVISIONS OF L1WS AND ORIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPI�ED WITH WHEfHER SPECIFIED HEREIN OR <br /> NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOL4TE OR CANCEL THE PROVI5104 OF ANY OTHER <br /> � STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFOFMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> I OWNER OF THIS PHOPERTY TO PERFORM THE WORK FOF WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br /> CO CTORS LAW 1827 R ND 296200 WqC. <br /> .�- �-OZ <br /> aWre o(Owner! nlrac Ihorized Agenl Date <br />