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�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 <br /> S�TE ADDRES�S�jO �j/o�� ,P�CEL TAJ(I.D.N PER�71T M <br /> `� � 4 373 �7U2 70G I �21�-�1Q <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ZIP PHONE <br /> ��►� S'�u/, �Ti�3 C�ar�:7��t ��Lf �=v�r�}� 9��3 - <br /> TENANT NAME CONTACT NAME PMONE <br /> ,5����<r� C����tlo� �1��1 �i��>�P Le c �1`Z — 0030� <br /> CONTRACTOR ADOIYtSS LP CONTR.UCENSE• <br /> PHCNE /Q��.�Y� � <br /> l (� <br /> PROPOSED USE OF BUILDING Buildl�g �Mechanical I Addilion HEAT SOURCE <br /> PERMIT R{.-1 Combination Plumbing WORN �leralion Electric <br /> � i ��,� TYPE �,,.J Demolition Sipn IYPE New � Gas <br /> U Sprinkler Repair/Maint. Other <br /> CONTRACT PRICE OF WORK ��-�1� _-- CITY OF EVERETT LQCAL SALES TAX COUE IS�105 I <br /> ,:JLI <br /> WCRK DESCRIPTON I <br /> �m S�A �� � �X /d � l ���/�/1ii'le� �{i/ ,S'r�'� <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF PIXTURE OR 17EM NO. TYPE OF FlXTURE OR REM <br /> i WATERCLOSET AIC—A/HA�VDLINGUMITS <br /> i _ BATHTUB _ FORCED AIR��STEMS <br /> LAVATOHY(WASH BASIN) HEAT PU�dP <br /> SHOWER _ UNITHEATERS <br /> KITCHEN SINK 8 DISPOSAL CLOTHES DRYER <br /> DIS��WASHER RANGE HOOD <br /> LAUNDRYTRAY WATER HEATER � <br /> CLOTHES WASHER METAL�IREPLACE/STOV <br /> URINAL FIREPLACE INSEflT <br /> DRINKING FOUNTAIN GAS FIFEPIACE <br /> FLOOR DRAIN _ GAS RANGE <br /> BACKFLOW P ENTER GAS PIPING <br /> SINK (SERV E/BAR/MOP/ETC.) EXHAUST FAN <br /> OTHER OTHER <br /> I HEHEBY CERITIFY THAT I HAVE RFAD AND EXAtdINEO THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL <br /> PROVISIONS OF LAWS AND ORIDINACES GOVEP.NING THIS TYPE C�WORK WILL B[COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br /> NOT. 7HE GRANTING OF A PERMIT DOES NOT PRESUME T�GIVE AUTHORITY TO VIOLATE OR CANCEL THE PRO�ISION OF ANY OTHER <br /> STATE OR LOCAL lAW REGUL4TING CONSTRUC710N OR T11E PERFJFMANCE OF CONSTRUCTION. THAT i AM ALiTHORIZED BV THE <br /> OWNER OF THIS PROPERTY TG PERFORM THE WORK FOP�VHIGi'.APPUCATION IG MADE AND I COMPLY WITH TNE STATE <br /> CONTFACTORS LAWJ 27 RCW AND 296.200 WAC. <br /> ��.3/0 2— <br /> Signature o�H•n /ContracloqAuthonzed Agem ate �/ <br /> Z � <br />..� ' <br />