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�ERMIT APPLICATA�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRE A PARCEL TAX I.D.# PERMIT a <br /> /SlD �jTOad'Cv � • .BOZ l l^O <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWN R ADDRE55 ZIP PHONE <br /> 5�.��k's �v� S�pPI� ��toz "R`'Sd�.U.�. Qsoo� �as3}$33 -i�is <br /> TENANTNAME ,( �` , CONT TNAME <br /> S� � �'(,0 J �P I � � , PHONE <br /> �c.�s u � C�� a Gu�K ,l.� ol C�?5'3) �33- ///T' <br /> C�j�/(!TRACTOR ,..� ADDRESS <br /> ►^QO � PI GF�( �C h c . 3 a g- 7 `fti Sdr�t��W. '� " Z�P CO TR.LICENSE N <br /> , 3 �oz �ooF TT �'Do6 a <br /> PHONE <br /> ��'3�735-�34'► <br /> PROPOSE�USE OF BUILDING nL+yt Building MeChanical Addilion HEAT SOURCE <br /> PERMIT � ) Com6inalion � plumbing WORK � Alferation Electric <br /> TYPE g Demolition Sign ITYPE New '� Gas <br /> Sprinkler Repair/Maint. � Oiher <br /> CONTRACT PRICE OF WORK `�I-J' [�OO Oo CITY OF EVERETT LOCAL SALES TAX CODG IS 3105 <br /> � J <br /> WORK DES IPTION p /� e � �/ <br /> �P.�wou.� O�d (�oo`���c�(ay¢tS �-6��'-r� �C� �( '� G Lt>oo� o�oc�r��i <br /> �S'1'a,Gf Q2z. 3„ PoLy_.1 so RiclStd ;GtS�( ��-, <br /> �. s l� Q�Ju.a G ra...,,c.�.J S�r'f'R� �Q�N /yr�i� (`oo� Sy 5^(w. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF flXTURE OR REM NO. TYPE OF FIXTURE OR ITEM <br /> _ WATER CLOSET _ A/C–A/HANDLING UNITS <br /> _ BATHTUB _ FOFCED AIR SYSTEMS <br /> _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER __ UNITHEATERS <br /> _ KITCHEN SINK& DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _! qANGE HOOD <br /> _ LAUNDRY TRAY _ 'A'ATER HEATER <br /> _ CLOTHES VJASHER _ tviETAI FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> i _ DRINKING FOUNTAIN <br /> � _ FLOOR DRAIN — GAS FIREPLACE <br /> � _ BACKFLOW PREVENTER — GAS RANGE <br /> , _ SINK(SERVICFJBAR/MOP/ETC. — GAS PIPING <br /> _ OTHER � _ EXHAUST FAN <br /> � _ _ OTHER <br /> � — <br /> I — <br /> � • <br /> ' I HEREBY CEFI7IFY?HAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AN�WARECT. ALL <br /> PROVISIONS OF LAWS AND OFIDINACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED HEREIN OR <br /> iNOT. THE GRANTING OF A PERMIT�OES NOT PRESUME TO GIVE AUTHORIIY TO VIOLATE OR CANCEL THE PHOV�SION OF ANY OTHER <br /> STATE OR LOCAL LAW qEGUL1TING CONSTRUCTION OR THE PERFORAIANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> � OW F HIS PROPE TO PERPORM THE WORK FOR WHICH APPLICATION IS MAOE AND I COMPLY WITH THE STATE <br /> � C TRA RS LAW 18. 7 CW AND 296200 WAC. <br /> i � �� /�_ s-a Z <br /> Signature f O�vner/Contractor/Authorized Agent Date <br />