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( � <br /> PEriMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> i 425-257-8810- FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D. k PERMIT M i <br /> �2S ��°wQ` ocv3 S�3s,oo�m oc93�a3ssoivoa IY) �So�-c�d-�O � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS ���W.� ZIP PHONE <br /> 5,����.,��, �,�.� .�,� . /iz�r /�y�� ,4�e tiF. , �. yPov.r-o9yo <br /> TENANTNAME CONTACTNAME PHONE <br /> JAT�I/,v • S�c��P �J-�-� . �A�e �a�son . � ,3_ � `(pS�!J <br /> CONTRACTOR 0—r1Y N���Z� �A� A�DRESS GJ� ��� (pZJ ZIP CONTR.UCENSE M <br /> i( � n J `, <br /> PHONE J�l.%T.0 r',f'f1��'��f.'� G!/�l. 9P�� `,I�s7/^�QOS�S� <br /> =�i o — 897- 8��a <br /> PROPOSE�USE OF BUILDING Bwlding MeChaniCal Addition MEAT OURCE <br /> PERMIT R Combinalion Plumbing WORK �Altemtion Electnc I <br /> TYPE Demolilion Sign TYPE New Gas <br /> Sprinkler Repa�r/Mamt. Other <br /> CONTRACT PRICE OF WORK �/J/'i1O i CITY OF EVEREl7 LOCAL SALES TAX COOE IS 3105 <br /> v <br /> WORKOESCRIPTION i � �a,��j� ��� �Q����7{y> <br /> 1.lisrv.lLa�.u•ti cF oN�e �•v��d � <br /> /��C7-/r� A�C.O C.�-�f' �PST�'in ���a.�S�� fi� /Y.3 :��l�..ti. D�. /yf-SI�.sT3. <br /> /f�7.F, " 1....s'T,7LL_ o�e l.�ci G�Fi/7'A�t7 T.Cerrnv-ST�r A.vO /ti�i.�ir1�• <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE Oq ITEM NO. TYPE OF FIXTURE OR ITEM <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 i <br /> DISHWASHER RANGE HOOD � <br /> LAUNDFY TRAY WATER HEATER <br /> CLOTHES WASHER METAL FIREPLACE/STOVE � <br /> URINAL FIREPLACE WSERT <br /> DRINKING FOUNTAIN GAS FIREPLACE <br /> FLOOR DRAIN GAS RANGE <br /> _ BACKFLOW PREVENTER GAS PIPING <br /> _ SINK(SERVICEE3AR/MOP/ETC.) � EXHAUST FAN <br /> OTHER OTHF_R <br /> I HEFiEBV CEFITIFY THAT I HAVE R[AD AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> PROVISIONS OF L1W5 AND ORIDINACES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED WITH WHEfl1ER SPECIFIED HEPEIN OR <br /> NOT, THE GRANTING OP A PERMIT DOES NOT PRESUIdE TO GIVE AUTHORIN TO VIOL4TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR IOCAL LAW REGULATING CONSTRUCTION OR 7HE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> OWNER IS PROPE TY'T PERFORM THE WORK fOR WHICH APPLICATION IS MAOE AN01 COMPLY WITH THE STATE <br /> CON�� 18 � W AND 296.200 WAC. <br /> � � W <br /> Signature ol Ow Conlractor/Authonzed Agent �Oale <br />